1
|
Marvaso G, Isaksson LJ, Zaffaroni M, Vincini MG, Summers PE, Pepa M, Corrao G, Mazzola GC, Rotondi M, Mastroleo F, Raimondi S, Alessi S, Pricolo P, Luzzago S, Mistretta FA, Ferro M, Cattani F, Ceci F, Musi G, De Cobelli O, Cremonesi M, Gandini S, La Torre D, Orecchia R, Petralia G, Jereczek-Fossa BA. Can we predict pathology without surgery? Weighing the added value of multiparametric MRI and whole prostate radiomics in integrative machine learning models. Eur Radiol 2024; 34:6241-6253. [PMID: 38507053 DOI: 10.1007/s00330-024-10699-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/29/2024] [Accepted: 02/18/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To test the ability of high-performance machine learning (ML) models employing clinical, radiological, and radiomic variables to improve non-invasive prediction of the pathological status of prostate cancer (PCa) in a large, single-institution cohort. METHODS Patients who underwent multiparametric MRI and prostatectomy in our institution in 2015-2018 were considered; a total of 949 patients were included. Gradient-boosted decision tree models were separately trained using clinical features alone and in combination with radiological reporting and/or prostate radiomic features to predict pathological T, pathological N, ISUP score, and their change from preclinical assessment. Model behavior was analyzed in terms of performance, feature importance, Shapley additive explanation (SHAP) values, and mean absolute error (MAE). The best model was compared against a naïve model mimicking clinical workflow. RESULTS The model including all variables was the best performing (AUC values ranging from 0.73 to 0.96 for the six endpoints). Radiomic features brought a small yet measurable boost in performance, with the SHAP values indicating that their contribution can be critical to successful prediction of endpoints for individual patients. MAEs were lower for low-risk patients, suggesting that the models find them easier to classify. The best model outperformed (p ≤ 0.0001) clinical baseline, resulting in significantly fewer false negative predictions and overall was less prone to under-staging. CONCLUSIONS Our results highlight the potential benefit of integrative ML models for pathological status prediction in PCa. Additional studies regarding clinical integration of such models can provide valuable information for personalizing therapy offering a tool to improve non-invasive prediction of pathological status. CLINICAL RELEVANCE STATEMENT The best machine learning model was less prone to under-staging of the disease. The improved accuracy of our pathological prediction models could constitute an asset to the clinical workflow by providing clinicians with accurate pathological predictions prior to treatment. KEY POINTS • Currently, the most common strategies for pre-surgical stratification of prostate cancer (PCa) patients have shown to have suboptimal performances. • The addition of radiological features to the clinical features gave a considerable boost in model performance. Our best model outperforms the naïve model, avoiding under-staging and resulting in a critical advantage in the clinic. •Machine learning models incorporating clinical, radiological, and radiomics features significantly improved accuracy of pathological prediction in prostate cancer, possibly constituting an asset to the clinical workflow.
Collapse
Affiliation(s)
- Giulia Marvaso
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | - Maria Giulia Vincini
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | - Paul Eugene Summers
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Matteo Pepa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Corrao
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | - Marco Rotondi
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Federico Mastroleo
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- University of Piemonte Orientale, Novara, Italy
| | - Sara Raimondi
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Sarah Alessi
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Pricolo
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Stefano Luzzago
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Alessandro Mistretta
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Matteo Ferro
- Division of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Cattani
- Medical Physics Unit, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Ceci
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Nuclear Medicine, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Gennaro Musi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Ottavio De Cobelli
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Marta Cremonesi
- Radiation Research Unit, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Davide La Torre
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- SKEMA Business School, Université Côte d'Azur, Sophia Antipolis, France
| | - Roberto Orecchia
- Scientific Directorate, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| |
Collapse
|
2
|
Sitharthan D, Kang S, Treacy PJ, Bird J, Alexander K, Karunaratne S, Leslie S, Chan L, Steffens D, Thanigasalam R. The Sensitivity and Specificity of Multiparametric Magnetic Resonance Imaging and Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography for Predicting Seminal Vesicle Invasion in Clinically Significant Prostate Cancer: A Multicenter Retrospective Study. J Clin Med 2024; 13:4424. [PMID: 39124692 PMCID: PMC11312943 DOI: 10.3390/jcm13154424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: The presence of seminal vesicle invasion (SVI) in prostate cancer (PCa) is associated with poorer postoperative outcomes. This study evaluates the predictive value of magnetic resonance imaging (MRI) and prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) for SVI in PCa. Methods: This cohort study included consecutive robotic prostatectomy patients for PCa at three Australian tertiary referral centres between April 2016 and September 2022. MRI and PSMA PET/CT results, clinicopathological variables, including age, BMI, prostate-specific antigen (PSA), PSA density, DRE, Biopsy Gleason score, Positive biopsy cores, PIRADS v2.1 score, MRI volume and MRI lesion size were extracted. The sensitivity, specificity, and accuracy of MRI and PSMA PET/CT for predicting SVI were compared with the histopathological results by receiver operating characteristic (ROC) analysis. Subgroup univariate and multivariate analysis was performed. Results: Of the 528 patients identified, 86 had SVI on final pathology. MRI had a low sensitivity of 0.162 (95% CI: 0.088-0.261) and a high specificity of 0.963 (95% CI: 0.940-0.979). The PSMA PET/CT had a low sensitivity of 0.439 (95% CI: 0.294-0591) and a high specificity of 0.933 (95% CI: 0.849-0.969). When MRI and PSMA PET/CT were used in combination, the sensitivity and specificity improved to 0.514 (95%CI: 0.356-0.670) and 0.880 (95% CI: 0.813-0.931). The multivariate regression showed a higher biopsy Gleason score (p = 0.033), higher PSA (p < 0.001), older age (p = 0.001), and right base lesions (p = 0.003) to be predictors of SVI. Conclusions: MRI and PSMA PET/CT independently underpredicted SVI. The sensitivity and AUC improved when they were used in combination. Multiple clinicopathological factors were associated with SVI on multivariate regression and predictive models incorporating this information may improve oncological outcomes.
Collapse
Affiliation(s)
- Darshan Sitharthan
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Missenden Road, Sydney, NSW 2050, Australia
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
- Department of Urology, Royal Prince Alfred Hospital (RPAH), Sydney, NSW 2050, Australia
| | - Song Kang
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Missenden Road, Sydney, NSW 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW 2050, Australia
| | - Patrick-Julien Treacy
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Missenden Road, Sydney, NSW 2050, Australia
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Jacob Bird
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Missenden Road, Sydney, NSW 2050, Australia
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW 2050, Australia
| | - Kate Alexander
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Missenden Road, Sydney, NSW 2050, Australia
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW 2050, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Missenden Road, Sydney, NSW 2050, Australia
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW 2050, Australia
| | - Scott Leslie
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Missenden Road, Sydney, NSW 2050, Australia
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
- Department of Urology, Royal Prince Alfred Hospital (RPAH), Sydney, NSW 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW 2050, Australia
| | - Lewis Chan
- Department of Urology, Concord Repatriation General Hospital (CRGH), Sydney, NSW 2139, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Missenden Road, Sydney, NSW 2050, Australia
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW 2050, Australia
| | - Ruban Thanigasalam
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Missenden Road, Sydney, NSW 2050, Australia
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW 2050, Australia
- Department of Urology, Concord Repatriation General Hospital (CRGH), Sydney, NSW 2139, Australia
| |
Collapse
|
3
|
Zawaideh JP, Caglic I, Sushentsev N, Priest AN, Warren AY, Carmisciano L, Barrett T. MRI assessment of seminal vesicle involvement by prostate cancer using T2 signal intensity and volume. Abdom Radiol (NY) 2024; 49:2534-2539. [PMID: 38734785 DOI: 10.1007/s00261-024-04349-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/17/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Seminal vesicle involvement (SVI) in patients with newly diagnosed prostate cancer is associated with high rates of treatment failure and tumor recurrence; correct identification of SVI allows for effective management decisions and surgical planning. METHODS This single-center retrospective study analyzed MR images of the seminal vesicles from patients undergoing radical prostatectomy with confirmed T3b disease, comparing them to a control group without SVI matched for age and Gleason grade with a final stage of T2 or T3a. Seminal vesicles were segmented by an experienced uroradiologist, "raw" and bladder-normalized T2 signal intensity, as well as SV volume, were obtained. RESULTS Among the 82 patients with SVI, 34 (41.6%) had unilateral invasion, and 48 (58.4%) had bilateral disease. There was no statistically significant difference in the degree of distension between normal and involved seminal vesicles (P = 0.08). Similarly, no statistically significant difference was identified in the raw SV T2 signal intensity (P = 0.09) between the groups. In the 159 patients analyzed, SVI was prospectively suspected in 10 of 82 patients (specificity, 100%; sensitivity, 12.2%). In all these cases, lesions macroscopically invaded the seminal vesicle, and the raw T2 signal intensity was significantly lower than that in the SVI and control groups (P = 0.02 and 0.01). CONCLUSION While signal intensity measurements in T2-weighted images may provide insight into T3b disease, our findings suggest that this data alone is insufficient to reliably predict SVI, indicating the need for further investigation and complementary diagnostic approaches.
Collapse
Affiliation(s)
- Jeries P Zawaideh
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Iztok Caglic
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Andrew N Priest
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Anne Y Warren
- Department of Pathology, Addenbrooke's Hospital, Cambridge, UK
| | - Luca Carmisciano
- Department of Health Sciences (DISSAL), Biostatistics Section, University of Genoa, Genoa, Italy
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| |
Collapse
|
4
|
Laschena L, Messina E, Flammia RS, Borrelli A, Novelli S, Messineo D, Leonardo C, Sciarra A, Ciardi A, Catalano C, Panebianco V. What the urologist needs to know before radical prostatectomy: MRI effective support to pre-surgery planning. LA RADIOLOGIA MEDICA 2024; 129:1048-1061. [PMID: 38918291 PMCID: PMC11252184 DOI: 10.1007/s11547-024-01831-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 05/23/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Radical prostatectomy (RP) is recommended in case of localized or locally advanced prostate cancer (PCa), but it can lead to side effects, including urinary incontinence (UI) and erectile dysfunction (ED). Magnetic resonance imaging (MRI) is recommended for PCa diagnosis and staging, but it can also improve preoperative risk-stratification. PURPOSE This nonsystematic review aims to provide an overview on factors involved in RP side effects, highlighting anatomical and pathological aspects that could be included in a structured report. EVIDENCE SYNTHESIS Considering UI evaluation, MR can investigate membranous urethra length (MUL), prostate volume, the urethral sphincter complex, and the presence of prostate median lobe. Longer MUL measurement based on MRI is linked to a higher likelihood of achieving continence restoration. For ED assessment, MRI and diffusion tensor imaging identify the neurovascular bundle and they can aid in surgery planning. Finally, MRI can precisely describe extra-prostatic extension, prostate apex characteristics and lymph-node involvement, providing valuable preoperative information for PCa treatment. CONCLUSIONS Anatomical principals structures involved in RP side effects can be assessed with MR. A standardized MR report detailing these structures could assist urologists in planning optimal and tailored surgical techniques, reducing complications, and improving patients' care.
Collapse
Affiliation(s)
- Ludovica Laschena
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Emanuele Messina
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Rocco Simone Flammia
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Antonella Borrelli
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Simone Novelli
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, Rome, Italy
- Liver Failure Group, Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, UK
| | - Daniela Messineo
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Costantino Leonardo
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal-Infant and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Ciardi
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy.
| |
Collapse
|
5
|
Kohan A, Hanneman K, Mirshahvalad SA, Afaq A, Mallak N, Metser U, Veit-Haibach P. Current Applications of PET/MR: Part II: Clinical Applications II. Can Assoc Radiol J 2024:8465371241255904. [PMID: 38836428 DOI: 10.1177/08465371241255904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
Due to the major improvements in the hardware and image reconstruction algorithms, positron emission tomography/magnetic resonance imaging (PET/MR) is now a reliable state-of-the-art hybrid modality in medical practice. Currently, it can provide a broad range of advantages in preclinical and clinical imaging compared to single-modality imaging. In the second part of this review, we discussed the further clinical applications of PET/MR. In the chest, PET/MR has particular potential in the oncology setting, especially when utilizing ultrashort/zero echo time MR sequences. Furthermore, cardiac PET/MR can provide reliable information in evaluating myocardial inflammation, cardiac amyloidosis, myocardial perfusion, myocardial viability, atherosclerotic plaque, and cardiac masses. In gastrointestinal and hepato-pancreato-biliary malignancies, PET/MR is able to precisely detect metastases to the liver, being superior over the other imaging modalities. In genitourinary and gynaecology applications, PET/MR is a comprehensive diagnostic method, especially in prostate, endometrial, and cervical cancers. Its simultaneous acquisition has been shown to outperform other imaging techniques for the detection of pelvic nodal metastases and is also a reliable modality in radiation planning. Lastly, in haematologic malignancies, PET/MR can significantly enhance lymphoma diagnosis, particularly in detecting extra-nodal involvement. It can also comprehensively assess treatment-induced changes. Furthermore, PET/MR may soon become a routine in multiple myeloma management, being a one-stop shop for evaluating bone, bone marrow, and soft tissues.
Collapse
Affiliation(s)
- Andres Kohan
- University Medical Imaging Toronto, Toronto Joint Department Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Kate Hanneman
- University Medical Imaging Toronto, Toronto Joint Department Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Seyed Ali Mirshahvalad
- University Medical Imaging Toronto, Toronto Joint Department Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Asim Afaq
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nadine Mallak
- Department of Diagnostic Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Ur Metser
- University Medical Imaging Toronto, Toronto Joint Department Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Patrick Veit-Haibach
- University Medical Imaging Toronto, Toronto Joint Department Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
6
|
Lin Y, Johnson LA, Fennessy FM, Turkbey B. Prostate Cancer Local Staging with Magnetic Resonance Imaging. Radiol Clin North Am 2024; 62:93-108. [PMID: 37973247 PMCID: PMC10656475 DOI: 10.1016/j.rcl.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Accurate determination of the local stage of prostate cancer is crucial for treatment planning and prognosis. The primary objective of local staging is to distinguish between organ-confined and locally advanced disease, with the latter carrying a worse clinical prognosis. The presence of locally advanced disease features of prostate cancer, such as extra-prostatic extension, seminal vesicle invasion, and positive surgical margin, can impact the choice of treatment. Over the past decade, multiparametric MRI (mpMRI) has become the preferred imaging modality for the local staging of prostate cancer and has been shown to provide accurate information on the location and extent of disease. It has demonstrated superior performance compared to staging based on traditional clinical nomograms. Despite being a relatively new technique, mpMRI has garnered considerable attention and ongoing investigations. Therefore, in this review, we will discuss the current use of mpMRI on prostate cancer local staging.
Collapse
Affiliation(s)
- Yue Lin
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892, USA
| | - Latrice A Johnson
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892, USA
| | - Fiona M Fennessy
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, MSC 1182, Building 10, Room B3B85, Bethesda, MD 20892, USA.
| |
Collapse
|
7
|
Beatrici E, Filipas DK, Stone BV, Labban M, Qian Z, Lipsitz SR, Lughezzani G, Buffi NM, Cole AP, Trinh QD. Clinical stage and grade migration of localized prostate cancer at diagnosis during the past decade. Urol Oncol 2023; 41:483.e11-483.e19. [PMID: 37852818 DOI: 10.1016/j.urolonc.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/06/2023] [Accepted: 09/22/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES Early 2010s data suggest a reverse stage and grade migration towards more aggressive prostate cancer (PCa) at diagnosis, accelerated by the 2012 US Preventive Services Task Force recommendation against PSA screening. Using the National Cancer Database, we investigated the impact of the 2018 USPSTF recommendation and the COVID-19 outbreak on this shift. We hypothesized that the COVID-19 outbreak would further contribute to a stage and grade migration towards more aggressive disease. MATERIAL AND METHODS We identified men with localized PCa diagnosed between 2010 and 2020. We analyzed the shift in the proportion of PCa stratified according to D'Amico risk classification. We used multivariable logistic regression models to assess the association between year of diagnosis and dichotomous variables related to clinical stage and grade of PCa. Predicted probabilities with 95% CI were computed through marginal effect analyses. RESULTS We identified 910,898 men with localized PCa. The proportion of low-risk PCa almost halved from 34.9% in 2010 to 17.7% in 2020 (P < 0.001). Compared to 2010, we found in each year increased odds of: PSA≥10 ng/dL starting from 2012 (aOR2012 1.05; 95% CI, 1.02-1.08); cT3-T4 starting from 2015 (aOR2015 1.10; 95% CI, 1.03-1.17); ISUP GG 3-5 starting from 2011 (aOR2011 1.06; 95% CI, 1.03-1.08); and consequently, D'Amico intermediate/high-risk class starting from 2011 (aOR2011 1.03; 95% CI, 1.01-1.05). Fluctuations in the probabilities of PSA≥10 ng/dL and cT3-T4 at diagnosis were observed over time (all P < 0.001). The probability of PSA≥10 ng/dL peaked at 29.0% (95% CI, 28.0%-29.0%) in 2018, while the probability of cT3-T4 peaked at 3.7% (95% CI, 3.6%-3.8%) in 2020. All other outcome variables demonstrated a consistent upward shift (all P < 0.001), with the highest probabilities in 2020 for ISUP GG 3-5 (42.3%, 95% CI, 41.9%-42.6%) and D'Amico intermediate/high-risk (81.3%, 95% CI, 81.0%-81.6%). CONCLUSIONS Our study confirms an enduring shift towards a higher proportion of aggressive PCa at diagnosis, likely influenced by the COVID-19 pandemic. The impact of the 2018 USPSTF PCa screening recommendation on the proportion of aggressive PCa seems restricted and likely affected by the pandemic outbreak. Future investigations should evaluate the long-term effects of the 2018 USPSTF recommendations in the postpandemic setting.
Collapse
Affiliation(s)
- Edoardo Beatrici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, Humanitas Research Hospital - IRCCS, Milan, Italy
| | - Dejan K Filipas
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin V Stone
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Muhieddine Labban
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Zhiyu Qian
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Stuart R Lipsitz
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Urology, Humanitas Research Hospital - IRCCS, Milan, Italy
| | - Nicolò M Buffi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Urology, Humanitas Research Hospital - IRCCS, Milan, Italy
| | - Alexander P Cole
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| |
Collapse
|
8
|
van den Berg I, Soeterik TFW, van der Hoeven EJRJ, Claassen B, Brink WM, Baas DJH, Sedelaar JPM, Heine L, Tol J, van der Voort van Zyp JRN, van den Berg CAT, van den Bergh RCN, van Basten JPA, van Melick HHE. The Development and External Validation of Artificial Intelligence-Driven MRI-Based Models to Improve Prediction of Lesion-Specific Extraprostatic Extension in Patients with Prostate Cancer. Cancers (Basel) 2023; 15:5452. [PMID: 38001712 PMCID: PMC10670855 DOI: 10.3390/cancers15225452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
Adequate detection of the histopathological extraprostatic extension (EPE) of prostate cancer (PCa) remains a challenge using conventional radiomics on 3 Tesla multiparametric magnetic resonance imaging (3T mpMRI). This study focuses on the assessment of artificial intelligence (AI)-driven models with innovative MRI radiomics in predicting EPE of prostate cancer (PCa) at a lesion-specific level. With a dataset encompassing 994 lesions from 794 PCa patients who underwent robot-assisted radical prostatectomy (RARP) at two Dutch hospitals, the study establishes and validates three classification models. The models were validated on an internal validation cohort of 162 lesions and an external validation cohort of 189 lesions in terms of discrimination, calibration, net benefit, and comparison to radiology reporting. Notably, the achieved AUCs ranged from 0.86 to 0.91 at the lesion-specific level, demonstrating the superior accuracy of the random forest model over conventional radiological reporting. At the external test cohort, the random forest model was the best-calibrated model and demonstrated a significantly higher accuracy compared to radiological reporting (83% vs. 67%, p = 0.02). In conclusion, an AI-powered model that includes both existing and novel MRI radiomics improves the detection of lesion-specific EPE in prostate cancer.
Collapse
Affiliation(s)
- Ingeborg van den Berg
- Department of Urology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
- Department of Radiation Oncology, Division of Imaging & Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Magnetic Detection and Imaging Group, Technical Medical Centre, University of Twente, 7522 NH Enschede, The Netherlands
| | - Timo F. W. Soeterik
- Department of Urology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
- Department of Radiation Oncology, Division of Imaging & Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | | | - Bart Claassen
- Department of Radiology, Canisius Wilhelmina Hospital, 7522 NH Nijmegen, The Netherlands
| | - Wyger M. Brink
- Magnetic Detection and Imaging Group, Technical Medical Centre, University of Twente, 7522 NH Enschede, The Netherlands
| | - Diederik J. H. Baas
- Department of Urology, Canisius Wilhelmina Hospital, 7522 NH Nijmegen, The Netherlands
| | - J. P. Michiel Sedelaar
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Lizette Heine
- Quantib B.V., RadNet’s AI Division, 3012 KM Rotterdam, The Netherlands
| | - Jim Tol
- Quantib B.V., RadNet’s AI Division, 3012 KM Rotterdam, The Netherlands
| | | | - Cornelis A. T. van den Berg
- Department of Radiation Oncology, Division of Imaging & Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | | | - Jean-Paul A. van Basten
- Department of Urology, Canisius Wilhelmina Hospital, 7522 NH Nijmegen, The Netherlands
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | | |
Collapse
|
9
|
Handke AE, Ritter M, Albers P, Noldus J, Radtke JP, Krausewitz P. [Prostate cancer-multiparametric MRI and alternative approaches in intervention and therapy planning]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:1160-1168. [PMID: 37666944 DOI: 10.1007/s00120-023-02190-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND In recent years, multiparametric magnetic resonance imaging (mpMRI) of the prostate has gained importance and plays a crucial role in both personalized diagnostics and increasingly in the treatment planning for patients with prostate cancer. OBJECTIVE The aim of this study is to present established and innovative applications of MRI in the diagnosis and treatment of localized prostate cancer, evaluating their strengths and weaknesses. Furthermore, it will explore alternative approaches and compare them in a comprehensive manner. MATERIALS AND METHODS A systematic literature review on the application of mpMRI for biopsy and therapy planning was conducted. RESULTS The integration of modern imaging techniques, especially mpMRI, into the diagnostic algorithm has revolutionized prostate cancer diagnosis. MRI and MRI-guided biopsy detect more significant prostate cancer, with the potential to reduce unnecessary biopsies and the diagnosis of clinically insignificant carcinomas. In addition, MRI provides crucial information for risk stratification and treatment planning in prostate cancer patients, both before radical prostatectomy and during active surveillance. CONCLUSION Multiparametric MRI offers significant added value for the diagnosis and treatment of localized prostate cancer. The advancement of MRI analysis, such as the implementation of artificial intelligence algorithms, holds the potential for further enhancing imaging diagnostics.
Collapse
Affiliation(s)
- Analena Elisa Handke
- Marienhospital Herne, Universitätsklinikum, Ruhr-Universität Bochum, Herne, Deutschland
| | - Manuel Ritter
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Peter Albers
- Klinik für Urologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
- Abteilung für Personalisierte Früherkennung des Prostatakarzinoms, Deutsches Krebsforschungszentrum (dkfz), Heidelberg, Deutschland
| | - Joachim Noldus
- Marienhospital Herne, Universitätsklinikum, Ruhr-Universität Bochum, Herne, Deutschland
| | - Jan Philipp Radtke
- Klinik für Urologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
- Abteilung für Personalisierte Früherkennung des Prostatakarzinoms, Deutsches Krebsforschungszentrum (dkfz), Heidelberg, Deutschland
- Abteilung Radiologie, Deutsches Krebsforschungszentrum (dkfz), Heidelberg, Deutschland
| | - Philipp Krausewitz
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| |
Collapse
|
10
|
Unal S, Musicki B, Burnett AL. Cavernous nerve mapping methods for radical prostatectomy. Sex Med Rev 2023; 11:421-430. [PMID: 37500541 DOI: 10.1093/sxmrev/qead030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Preserving the cavernous nerves, the main autonomic nerve supply of the penis, is a major challenge of radical prostatectomy. Cavernous nerve injury during radical prostatectomy predominantly accounts for post-radical prostatectomy erectile dysfunction. The cavernous nerve is a bilateral structure that branches in a weblike distribution over the prostate surface and varies anatomically in individuals, such that standard nerve-sparing methods do not sufficiently sustain penile erection ability. As a consequence, researchers have focused on developing personalized cavernous nerve mapping methods applied to the surgical procedure aiming to improve postoperative sexual function outcomes. OBJECTIVES We provide an updated overview of preclinical and clinical data of cavernous nerve mapping methods, emphasizing their strengths, limitations, and future directions. METHODS A literature review was performed via Scopus, PubMed, and Google Scholar for studies that describe cavernous nerve mapping/localization. RESULTS Several cavernous nerve mapping methods have been investigated based on various properties of the nerve structures including stimulation techniques, spectroscopy/imaging techniques, and assorted combinations of these methods. More recent methods have portrayed the course of the main cavernous nerve as well as its branches based on real-time mapping, high-resolution imaging, and functional imaging. However, each of these methods has distinctive limitations, including low spatial accuracy, lack of standardization for stimulation and response measurement, superficial imaging depth, toxicity risk, and lack of suitability for intraoperative use. CONCLUSION While various cavernous nerve mapping methods have provided improvements in identification and preservation of the cavernous nerve during radical prostatectomy, no method has been implemented in clinical practice due to their distinctive limitations. To overcome the limitations of existing cavernous nerve mapping methods, the development of new imaging techniques and mapping methods is in progress. There is a need for further research in this area to improve sexual function outcomes and quality of life after radical prostatectomy.
Collapse
Affiliation(s)
- Selman Unal
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
- Department of Urology, Ankara Yildirim Beyazit University School of Medicine, Ankara 06800, Turkey
| | - Biljana Musicki
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Arthur L Burnett
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| |
Collapse
|
11
|
Wu S, Jiang Y, Liang Z, Chen S, Sun G, Ma S, Chen K, Liu R. Comprehensive analysis of predictive factors for upstaging in intraprostatic cancer after radical prostatectomy: Different patterns of spread exist in lesions at different locations. Cancer Med 2023; 12:17776-17787. [PMID: 37537798 PMCID: PMC10524000 DOI: 10.1002/cam4.6401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/14/2023] [Accepted: 07/22/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Accurate assessment of the clinical staging is crucial for determining the need for radical prostatectomy (RP) in prostate cancer (PCa). However, the current methods for PCa staging may yield incorrect results. This study aimed to comprehensively analyze independent predictors of postoperative upstaging of intraprostatic cancer. METHODS We conducted a retrospective analysis of data from intraprostatic cancer patients who underwent radical surgery between March 2019 and December 2022. Intraprostatic cancer was defined as a lesion confined to the prostate, excluding cases where multiparameter magnetic resonance imaging (mpMRI) showed the lesion in contact with the prostatic capsule. We assessed independent predictors of extraprostatic extension (EPE) and analyzed their association with positive surgical margin (PSM) status. In addition, based on the distance of the lesion from the capsule on mpMRI, we divided the patients into non-transition zone and transition zone groups for further analysis. RESULTS A total of 500 patients were included in our study. Logistic regression analysis revealed that biopsy Gleason grade group (GG) (odds ratio, OR: 1.370, 95% confidence interval, CI: 1.093-1.718) and perineural invasion (PNI) (OR: 2.746, 95% CI: 1.420-5.309) were predictive factors for postoperative EPE. Both biopsy GG and PNI were associated with lateral (GG: OR: 1.270, 95% CI: 1.074-1.501; PNI: OR: 2.733, 95% CI: 1.521-4.911) and basal (GG: OR: 1.491, 95% CI: 1.194-1.862; PNI: OR: 3.730, 95% CI: 1.929-7.214) PSM but not with apex PSM (GG: OR: 1.176, 95% CI: 0.989-1.399; PNI: OR: 1.204, 95% CI: 0.609-2.381) after RP. Finally, PNI was an independent predictor of EPE in the transition zone (OR: 11.235, 95% CI: 2.779-45.428) but not in the non-transition zone (OR: 1.942, 95% CI: 0.920-4.098). CONCLUSION PNI and higher GG may indicate upstaging of tumors in patients with intraprostatic carcinoma. These two factors are associated with PSM in locations other than the apex of the prostate. Importantly, cancer in the transition zone of the prostate is more likely to spread externally through nerve invasion than cancer in the non-transition zone.
Collapse
Affiliation(s)
- Shangrong Wu
- Department of UrologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
- Tianjin Institute of UrologyTianjinChina
| | - Yuchen Jiang
- Department of UrologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
- Tianjin Institute of UrologyTianjinChina
| | - Zhengxin Liang
- Department of UrologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
- Tianjin Institute of UrologyTianjinChina
| | - Shuaiqi Chen
- Department of UrologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
- Tianjin Institute of UrologyTianjinChina
| | - Guangyu Sun
- Department of UrologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
- Tianjin Institute of UrologyTianjinChina
| | - Shenfei Ma
- Department of UrologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
- Tianjin Institute of UrologyTianjinChina
| | - Kaifei Chen
- Department of UrologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
- Tianjin Institute of UrologyTianjinChina
| | - Ranlu Liu
- Department of UrologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
- Tianjin Institute of UrologyTianjinChina
| |
Collapse
|
12
|
Zhu M, Gao J, Han F, Yin L, Zhang L, Yang Y, Zhang J. Diagnostic performance of prediction models for extraprostatic extension in prostate cancer: a systematic review and meta-analysis. Insights Imaging 2023; 14:140. [PMID: 37606802 PMCID: PMC10444717 DOI: 10.1186/s13244-023-01486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/19/2023] [Indexed: 08/23/2023] Open
Abstract
PURPOSE In recent decades, diverse nomograms have been proposed to predict extraprostatic extension (EPE) in prostate cancer (PCa). We aimed to systematically evaluate the accuracy of MRI-inclusive nomograms and traditional clinical nomograms in predicting EPE in PCa. The purpose of this meta-analysis is to provide baseline summative and comparative estimates for future study designs. MATERIALS AND METHODS The PubMed, Embase, and Cochrane databases were searched up to May 17, 2023, to identify studies on prediction nomograms for EPE of PCa. The risk of bias in studies was assessed by using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). Summary estimates of sensitivity and specificity were obtained with bivariate random-effects model. Heterogeneity was investigated through meta-regression and subgroup analysis. RESULTS Forty-eight studies with a total of 57 contingency tables and 20,395 patients were included. No significant publication bias was observed for either the MRI-inclusive nomograms or clinical nomograms. For MRI-inclusive nomograms predicting EPE, the pooled AUC of validation cohorts was 0.80 (95% CI: 0.76, 0.83). For traditional clinical nomograms predicting EPE, the pooled AUCs of the Partin table and Memorial Sloan Kettering Cancer Center (MSKCC) nomogram were 0.72 (95% CI: 0.68, 0.76) and 0.79 (95% CI: 0.75, 0.82), respectively. CONCLUSION Preoperative risk stratification is essential for PCa patients; both MRI-inclusive nomograms and traditional clinical nomograms had moderate diagnostic performance for predicting EPE in PCa. This study provides baseline comparative values for EPE prediction for future studies which is useful for evaluating preoperative risk stratification in PCa patients. CRITICAL RELEVANCE STATEMENT This meta-analysis firstly evaluated the diagnostic performance of preoperative MRI-inclusive nomograms and clinical nomograms for predicting extraprostatic extension (EPE) in prostate cancer (PCa) (moderate AUCs: 0.72-0.80). We provide baseline estimates for EPE prediction, these findings will be useful in assessing preoperative risk stratification of PCa patients. KEY POINTS • MRI-inclusive nomograms and traditional clinical nomograms had moderate AUCs (0.72-0.80) for predicting EPE. • MRI combined clinical nomogram may improve diagnostic accuracy of MRI alone for EPE prediction. • MSKCC nomogram had a higher specificity than Partin table for predicting EPE. • This meta-analysis provided baseline and comparative estimates of nomograms for EPE prediction for future studies.
Collapse
Affiliation(s)
- MeiLin Zhu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - JiaHao Gao
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Fang Han
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - LongLin Yin
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - LuShun Zhang
- Department of Pathology and Pathophysiology, Chengdu Medical College, Development and Regeneration Key Laboratory of Sichuan Province, Chengdu, 610500, China
| | - Yong Yang
- School of Big Health & Intelligent Engineering, Chengdu Medical College, Chengdu, 610500, China.
| | - JiaWen Zhang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, 200040, China.
| |
Collapse
|
13
|
Kim SH, Cho SH, Kim WH, Kim HJ, Park JM, Kim GC, Ryeom HK, Yoon YS, Cha JG. Predictors of Extraprostatic Extension in Patients with Prostate Cancer. J Clin Med 2023; 12:5321. [PMID: 37629363 PMCID: PMC10455404 DOI: 10.3390/jcm12165321] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/05/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
PURPOSE To identify effective factors predicting extraprostatic extension (EPE) in patients with prostate cancer (PCa). METHODS This retrospective cohort study recruited 898 consecutive patients with PCa treated with robot-assisted laparoscopic radical prostatectomy. The patients were divided into EPE and non-EPE groups based on the analysis of whole-mount histopathologic sections. Histopathological analysis (ISUP biopsy grade group) and magnetic resonance imaging (MRI) (PI-RADS v2.1 scores [1-5] and the Mehralivand EPE grade [0-3]) were used to assess the prediction of EPE. We also assessed the clinical usefulness of the prediction model based on decision-curve analysis. RESULTS Of 800 included patients, 235 (29.3%) had EPE, and 565 patients (70.7%) did not (non-EPE). Multivariable logistic regression analysis showed that the biopsy ISUP grade, PI-RADS v2.1 score, and Mehralivand EPE grade were independent risk factors for EPE. In the regression assessment of the models, the best discrimination (area under the curve of 0.879) was obtained using the basic model (age, serum PSA, prostate volume at MRI, positive biopsy core, clinical T stage, and D'Amico risk group) and Mehralivand EPE grade 3. Decision-curve analysis showed that combining Mehralivand EPE grade 3 with the basic model resulted in superior net benefits for predicting EPE. CONCLUSION Mehralivand EPE grades and PI-RADS v2.1 scores, in addition to basic clinical and demographic information, are potentially useful for predicting EPE in patients with PCa.
Collapse
Affiliation(s)
- See Hyung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| | - Seung Hyun Cho
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Won Hwa Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Hye Jung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Jong Min Park
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| | - Gab Chul Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Hun Kyu Ryeom
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| | - Yu Sung Yoon
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| | - Jung Guen Cha
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| |
Collapse
|
14
|
Tu W, Gottumukkala RV, Schieda N, Lavallée L, Adam BA, Silverman SG. Perineural Invasion and Spread in Common Abdominopelvic Diseases: Imaging Diagnosis and Clinical Significance. Radiographics 2023; 43:e220148. [PMID: 37319024 DOI: 10.1148/rg.220148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Malignancies and other diseases may spread by multiple pathways, including direct extension, hematogenous spread, or via lymphatic vessels. A less-well-understood route is the peripheral nervous system, which is known as perineural spread (PNS). In addition to accounting for pain and other neurologic symptoms, PNS affects both disease prognosis and management. Although PNS is commonly discussed in relation to head and neck tumors, there is emerging data regarding PNS in abdominopelvic malignancies and other conditions such as endometriosis. Due to improved contrast and spatial resolution, perineural invasion, a finding heretofore diagnosed only at pathologic examination, can be detected at CT, MRI, and PET/CT. PNS most commonly manifests as abnormal soft-tissue attenuation extending along neural structures, and diagnosis of it is aided by optimizing imaging parameters, understanding pertinent anatomy, and becoming familiar with the typical neural pathways of spread that largely depend on the disease type and location. In the abdomen, the celiac plexus is a central structure that innervates the major abdominal organs and is the principal route of PNS in patients with pancreatic and biliary carcinomas. In the pelvis, the lumbosacral plexus and inferior hypogastric plexus are the central structures and principal routes of PNS in patients with pelvic malignancies. Although the imaging findings of PNS may be subtle, a radiologic diagnosis can have a substantial effect on patient care. Knowledge of anatomy and known routes of PNS and optimizing imaging parameters is of utmost importance in providing key information for prognosis and treatment planning. © RSNA, 2023 Supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. Quiz questions for this article are available through the Online Learning Center.
Collapse
Affiliation(s)
- Wendy Tu
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Ravi V Gottumukkala
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Nicola Schieda
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Luke Lavallée
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Benjamin A Adam
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Stuart G Silverman
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
15
|
Guerra FS, Eusebi L, Bartelli F, Cecchini S, Paci E, Guglielmi G. Staging of Prostate Cancer: Role of Multiparametric Magnetic Resonance Imaging in Different Risk Classes. UROLOGY RESEARCH & PRACTICE 2023; 49:216-224. [PMID: 37877822 PMCID: PMC10541521 DOI: 10.5152/tud.2023.22261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/29/2023] [Indexed: 10/26/2023]
Abstract
Using multiparametric magnetic resonance imaging, it is now possible to diagnose prostate cancer and categorize its risk. As it can accurately determine the extracapsu- lar extension of the tumor, invasion of seminal vesicles, involvement of lymph nodes, and the potential presence of bone metastases, multiparametric magnetic resonance imaging plays a crucial role not only in the diagnosis but also in the local staging of prostate cancer. The patients with a history of negative biopsy/increasing prostate- specific antigen and the existence of further data supporting its use in biopsy-naive patients and active surveillance are the most blatant indications for multiparametric magnetic resonance imaging in guidelines. The traditional clinical examination, pros- tate-specific antigen tests, and systematic biopsy are all enhanced by multiparametric magnetic resonance imaging, which will miss certain cancers due to insufficient size or changes in tissue density. The use of multiparametric magnetic resonance imaging is expected to rise, and further advances in the method will be crucial for the secure adoption of targeted therapeutic ideas. Here, we give a succinct overview of multipa- rametric magnetic resonance imaging's application to the identification and risk clas- sification of prostate cancer.
Collapse
Affiliation(s)
- Francesco Saverio Guerra
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
| | | | | | - Sara Cecchini
- Diagnostic Imaging, Clinical and Interventional Radiology, IRCCS INRCA, Ancona, Italy
| | - Enrico Paci
- Diagnostic Imaging, Clinical and Interventional Radiology, IRCCS INRCA, Ancona, Italy
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
- Radiology Unit, “Dimiccoli” Hospital, Barletta, Italy.
- Department of Radiology, Hospital IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, FG, Italy
| |
Collapse
|
16
|
Mingels C, Loebelenz LI, Huber AT, Alberts I, Rominger A, Afshar-Oromieh A, Obmann VC. Literature review: Imaging in prostate cancer. Curr Probl Cancer 2023:100968. [PMID: 37336689 DOI: 10.1016/j.currproblcancer.2023.100968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/09/2023] [Accepted: 05/20/2023] [Indexed: 06/21/2023]
Abstract
Imaging plays an increasingly important role in the detection and characterization of prostate cancer (PC). This review summarizes the key conventional and advanced imaging modalities including multiparametric magnetic resonance imaging (MRI) and positron emission tomography (PET) imaging and tries to instruct clinicians in finding the best image modality depending on the patient`s PC-stage. We aim to give an overview of the different image modalities and their benefits and weaknesses in imaging PC. Emphasis is put on primary prostate cancer detection and staging as well as on recurrent and castration resistant prostate cancer. Results from studies using various imaging techniques are discussed and compared. For the different stages of PC, advantages and disadvantages of the different imaging modalities are discussed. Moreover, this review aims to give an outlook about upcoming, new imaging modalities and how they might be implemented in the future into clinical routine. Imaging patients suffering from PC should aim for exact diagnosis, accurate detection of PC lesions and should mirror the true tumor burden. Imaging should lead to the best patient treatment available in the current PC-stage and should avoid unnecessary therapeutic interventions. New image modalities such as long axial field of view PET/CT with photon-counting CT and radiopharmaceuticals like androgen receptor targeting radiopharmaceuticals open up new possibilities. In conclusion, PC imaging is growing and each image modality is aiming for improvement.
Collapse
Affiliation(s)
- Clemens Mingels
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
| | - Laura I Loebelenz
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Adrian T Huber
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Ian Alberts
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Ali Afshar-Oromieh
- Department of Nuclear Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Verena C Obmann
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| |
Collapse
|
17
|
Caporale AS, Nezzo M, Di Trani MG, Maiuro A, Miano R, Bove P, Mauriello A, Manenti G, Capuani S. Acquisition Parameters Influence Diffusion Metrics Effectiveness in Probing Prostate Tumor and Age-Related Microstructure. J Pers Med 2023; 13:jpm13050860. [PMID: 37241031 DOI: 10.3390/jpm13050860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
This study aimed to investigate the Diffusion-Tensor-Imaging (DTI) potential in the detection of microstructural changes in prostate cancer (PCa) in relation to the diffusion weight (b-value) and the associated diffusion length lD. Thirty-two patients (age range = 50-87 years) with biopsy-proven PCa underwent Diffusion-Weighted-Imaging (DWI) at 3T, using single non-zero b-value or groups of b-values up to b = 2500 s/mm2. The DTI maps (mean-diffusivity, MD; fractional-anisotropy, FA; axial and radial diffusivity, D// and D┴), visual quality, and the association between DTI-metrics and Gleason Score (GS) and DTI-metrics and age were discussed in relation to diffusion compartments probed by water molecules at different b-values. DTI-metrics differentiated benign from PCa tissue (p ≤ 0.0005), with the best discriminative power versus GS at b-values ≥ 1500 s/mm2, and for b-values range 0-2000 s/mm2, when the lD is comparable to the size of the epithelial compartment. The strongest linear correlations between MD, D//, D┴, and GS were found at b = 2000 s/mm2 and for the range 0-2000 s/mm2. A positive correlation between DTI parameters and age was found in benign tissue. In conclusion, the use of the b-value range 0-2000 s/mm2 and b-value = 2000 s/mm2 improves the contrast and discriminative power of DTI with respect to PCa. The sensitivity of DTI parameters to age-related microstructural changes is worth consideration.
Collapse
Affiliation(s)
- Alessandra Stella Caporale
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, 66100 Chieti, Italy
- Institute for Advanced Biomedical Technologies (ITAB), 'G. d'Annunzio' University of Chieti-Pescara, 66100 Chieti, Italy
| | - Marco Nezzo
- Interventional Radiology Unit, Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Maria Giovanna Di Trani
- Centro Fermi-Museo Storico della Fisica e Centro Studi e Ricerche Enrico Fermi, 00184 Rome, Italy
| | - Alessandra Maiuro
- CNR ISC, c/o Physics Department, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
- Physics Department, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Roberto Miano
- Division of Urology, Department of Surgical Sciences, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Pierluigi Bove
- Division of Urology, Department of Surgical Sciences, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Alessandro Mauriello
- Anatomic Pathology, Department of Experimental Medicine, PTV Foundation, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Guglielmo Manenti
- Department of Biomedicine and Prevention, UOC Radiology PTV Foundation, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Silvia Capuani
- CNR ISC, c/o Physics Department, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
- Physics Department, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| |
Collapse
|
18
|
Guerra A, Flor-de-Lima B, Freire G, Lopes A, Cassis J. Radiologic-pathologic correlation of prostatic cancer extracapsular extension (ECE). Insights Imaging 2023; 14:88. [PMID: 37191739 DOI: 10.1186/s13244-023-01428-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
Recent advancements on nerve-sparing robotic prostatectomy allow fewer side effects such as urinary incontinence and sexual dysfunction. To perform such techniques, it is essential for the surgeon to know if the neurovascular bundle is involved. Despite being the gold-standard imaging method for Prostate Cancer (PCa) staging, Magnetic Resonance Imaging (MRI) lacks high specificity for detecting extracapsular extension (ECE). Therefore, it is essential to understand the pathologic aspects of ECE to better evaluate the MRI findings of PCa. We reviewed the normal MRI appearance of the prostate gland and the periprostatic space and correlated them to prostatectomy specimens. The different findings of ECE and neurovascular bundle invasion are exemplified with images of both MRI and histologic specimens.
Collapse
Affiliation(s)
- Adalgisa Guerra
- Department of Radiology, Hospital da Luz Lisboa, Avenida Lusíada 100, 1500-650, Lisbon, Portugal.
- Faculdade de Ciências Médicas, NOVA Medical School, Lisbon, Portugal.
| | | | | | - Ana Lopes
- Pathology Department, Hospital da Luz Lisboa, Lisbon, Portugal
| | - João Cassis
- Pathology Department, Hospital da Luz Lisboa, Lisbon, Portugal
| |
Collapse
|
19
|
Georgiev A, Chervenkov L, Doykov M, Doykova K, Uchikov P, Tsvetkova S. Surveillance Value of Apparent Diffusion Coefficient Maps: Multiparametric MRI in Active Surveillance of Prostate Cancer. Cancers (Basel) 2023; 15:1128. [PMID: 36831471 PMCID: PMC9953850 DOI: 10.3390/cancers15041128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND This study aims to establish the value of apparent diffusion coefficient maps and other magnetic resonance sequences for active surveillance of prostate cancer. The study included 530 men with an average age of 66, who were under surveillance for prostate cancer. We have used multiparametric magnetic resonance imaging with subsequent transperineal biopsy (TPB) to verify the imaging findings. RESULTS We have observed a level of agreement of 67.30% between the apparent diffusion coefficient (ADC) maps, other magnetic resonance sequences, and the biopsy results. The sensitivity of the apparent diffusion coefficient is 97.14%, and the specificity is 37.50%. According to our data, apparent diffusion coefficient is the most accurate sequence, followed by diffusion imaging in prostate cancer detection. CONCLUSIONS Based on our findings we advocate that the apparent diffusion coefficient should be included as an essential part of magnetic resonance scanning protocols for prostate cancer in at least bi-parametric settings. The best option will be apparent diffusion coefficient combined with diffusion imaging and T2 sequences. Further large-scale prospective controlled studies are required to define the precise role of multiparametric and bi-parametric magnetic resonance in the active surveillance of prostate cancer.
Collapse
Affiliation(s)
- Aleksandar Georgiev
- Department of Diagnostic Imaging, Medical Faculty, Medical University Plovdiv, Bul. Vasil Aprilov 15A, 4002 Plovdiv, Bulgaria
- Department of Diagnostic Imaging, Complex Oncology Center Plovdiv, ul. Pere Toshev 62, 4004 Plovdiv, Bulgaria
| | - Lyubomir Chervenkov
- Department of Diagnostic Imaging, Medical Faculty, Medical University Plovdiv, Bul. Vasil Aprilov 15A, 4002 Plovdiv, Bulgaria
- Research Complex for Translational Neuroscience, Medical University of Plovdiv, Bul. Vasil Aprilov 15A, 4002 Plovdiv, Bulgaria
| | - Mladen Doykov
- Department of Urology and General Medicine, Medical Faculty, Medical University Plovdiv, Bul. Vasil Aprilov 15A, 4002 Plovdiv, Bulgaria
| | - Katya Doykova
- Department of Diagnostic Imaging, Medical Faculty, Medical University Plovdiv, Bul. Vasil Aprilov 15A, 4002 Plovdiv, Bulgaria
| | - Petar Uchikov
- Department of Special Surgery, Medical Faculty, Medical University Plovdiv, Bul. Vasil Aprilov 15A, 4002 Plovdiv, Bulgaria
| | - Silvia Tsvetkova
- Department of Diagnostic Imaging, Medical Faculty, Medical University Plovdiv, Bul. Vasil Aprilov 15A, 4002 Plovdiv, Bulgaria
| |
Collapse
|
20
|
The impact of local staging of prostate cancer determined on MRI or DRE at time of radical prostatectomy on progression-free survival: A Will Rogers phenomenon. Urol Oncol 2023; 41:106.e9-106.e16. [PMID: 36564258 DOI: 10.1016/j.urolonc.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/01/2022] [Accepted: 10/20/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION We aimed to test whether the current practice of using mpMRI stage might lead to a Will Rogers phenomenon with a stage migration compared to DRE in men undergoing radical prostatectomy. MATERIAL AND METHODS A total of 572 consecutive patients who underwent radical prostatectomy at a single institution (2007-2017) were included. Clinical stage using digital rectal examination was determined on table by the operating surgeon; mpMRI and pathological stage were recorded after tumor board review. Progression-free survival (PFS) was defined as no rising PSA, no adjuvant/salvage treatment, and no metastases or mortality. PFS was compared between groups and a model incorporating mpMRI into the EAU risk groups was created. RESULTS Median age was 63 years (IQR 58.5-67) and median PSA was 8.9 ng/ml (IQR 6.5-13.2). Using DRE stage, 20% were NCCN low risk, 43% were intermediate, and 37% high. Median follow-up was 48 months (IQR 22-73). Estimated PFS at 1, 3, and 5 years was 75%, 59%, and 54%, respectively. When comparing PFS between DRE and mpMRI stages, patients deemed T1 (P < 0.01) or T3 (P = 0.03) by mpMRI showed better outcomes than patients staged T1 or T3 by DRE. On univariable analysis lower risk for failure was seen for MRI T1 disease (HR 0.10 95%, CI 0.01-0.73, P = 0.02) or MRI T3 (HR 0.70, CI 0.51-0.97, P = 0.03). On multivariable analysis, only MRI T1 remained a significant predictor (HR 0.08, 95% CI 0.01-0.59, P = 0.01). The subsequent, modified EAU risk model using both DRE and mpMRI performed significantly better than the DRE model. CONCLUSION PFS based on mpMRI is not the same as DRE staging. Current risk groups which use DRE should be used with caution in whom local stage is based on mpMRI. Our modified EAU-risk categories can provide greater accuracy.
Collapse
|
21
|
Yang NS, Johnson EG, Palm CA, Burton JH, Rebhun RB, Kent MS, Culp WTN. MRI characteristics of canine prostatic neoplasia. Vet Radiol Ultrasound 2023; 64:105-112. [PMID: 36065472 DOI: 10.1111/vru.13149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 01/25/2023] Open
Abstract
Magnetic resonance imaging (MRI) has been used to evaluate dogs with suspected prostatic neoplasia, however, published studies describing MRI characteristics of canine prostatic neoplasia are currently lacking. The aims of the current retrospective case series study were to describe MRI findings of the pelvic region in dogs with a histopathologic or cytologic diagnosis of prostatic neoplasia. Retrospective analysis of these images was then performed by a board-certified veterinary radiologist for shared imaging characteristics. The most consistent characteristics were heterogeneous hyperintensity of the tumor on T2-weighted images (10/10) and short tau inversion recovery images (10/10), prostatic capsular margin distortion by the tumor (10/10), cavitations (10/10), complete effacement of the prostatic architecture (9/10), neurovascular bundle (NVB) compression or invasion (9/10), heterogeneous isointensity of the tumor on T1-weighted images (9/10), and strong contrast enhancement of the tumor (8/10). Additional features included an overlying pattern of distorted radiating striations (7/10), regional lymphadenomegaly (5/10), mineralization within the mass (5/10), urinary bladder trigone involvement (6/10), and post-prostatic urethral involvement (7/10). These findings supported the use of MRI as an adjunct imaging modality for diagnosis and therapeutic planning of prostatic neoplasia and including prostatic neoplasia as a likely differential diagnosis for dogs with these MRI characteristics.
Collapse
Affiliation(s)
- Nicole S Yang
- William R. Pritchard Veterinary Medical Teaching Hospital, Davis, California, USA
| | - Eric G Johnson
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California, USA
| | - Carrie A Palm
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California Davis, Davis, California, USA
| | - Jenna H Burton
- Department of Clinical Sciences, Colorado State University College of Veterinary Medicine, Fort Collins, Colorado, USA
| | - Robert B Rebhun
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California, USA
| | - Michael S Kent
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California, USA
| | - William T N Culp
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California, USA
| |
Collapse
|
22
|
Colarieti A, Shaida N, Thiruchelvam N, Barrett T. Transperineal Ultrasound Before and After Prostatectomy: Technical Approach and Description. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:3125-3135. [PMID: 35866181 PMCID: PMC9796877 DOI: 10.1002/jum.16064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
This study assessed the feasibility of dynamic transperineal ultrasound (TPUS) pre/post-radical prostatectomy (RP). Ninety-eight patients were scanned pre-operatively and at four time-points post-operatively. TPUS was performed in 98 patients using an abdominal transducer at rest, during pelvic floor contraction (PFC) and Valsalva (VS) maneuver in supine and standing positions. Urodynamic evaluations included bladder neck angle at rest/PFC/VS, and degree of bladder neck movement. Pre-operative and post-operative measurements were technically feasible in >85% (supine) and >90% (standing) of patients. TPUS offers a reliable non-invasive dynamic assessment of the pelvic floor post-prostatectomy and may prove a useful adjunct for guiding exercises to preserve continence.
Collapse
Affiliation(s)
| | - Nadeem Shaida
- Department of Radiology, Addenbrooke's HospitalUniversity of CambridgeCambridgeUK
| | - Nikesh Thiruchelvam
- Department of Urology, Addenbrooke's HospitalUniversity of CambridgeCambridgeUK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's HospitalUniversity of CambridgeCambridgeUK
- CamPARI Clinic, Addenbrooke's HospitalUniversity of CambridgeCambridgeUK
| |
Collapse
|
23
|
Wang Y, Tang Y, Gao X, Gan Y, Hu S, Chen MF, Cai Y. Optimization of prostate cancer patient lymph node staging via the integration of neutrophil-lymphocyte ratios, platelet-lymphocyte ratios, and 68 Ga-PSMA-PET-derived SUVmax values. Prostate 2022; 82:1415-1421. [PMID: 35860907 DOI: 10.1002/pros.24415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/12/2022] [Accepted: 07/04/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND At present, standardized parameters for quantitatively evaluating 68 Ga-PSMA-PET/CT outcomes when diagnosing lymph node metastasis in prostate cancer patients are lacking. Inflammatory hematological biomarkers offer value as robust predictors of certain cancer-related outcomes. The present study was thus developed to explore approaches to improving the utility of 68 Ga-PSMA-PET/CT for diagnosing lymph node metastasis through the combined evaluation of inflammatory hematological markers in prostate cancer patients. METHODS Pretreatment patient details including age, initial TPSA levels, hematological findings, biopsy pathology results (Gleason score and ISUP grouping), radical pathology results, and imaging details were collected. Optimal cutoff values for each predictor then being determined based upon Youden's index, with univariate and multivariate analyses were then used to identify independent predictors of lymph node metastasis and used to construct a nomogram. RESULT Independent predictors of lymph node metastasis in this patient cohort included SUVmax (odds ratio [OR]: 30.549, 95% confidence interval [CI]: 10.855-85.973, p < 0.001), neutrophil-lymphocyte ratio (OR:8.221, 95%CI: 1.335-50.614, p = 0.023), platelet-lymphocyte ratio (OR:8.221, 95% CI: 1.335-50.614, p = 0.023), initial TPSA (OR:2.761, 95% CI: 1.132-6.733, p = 0.026), and clinical T-stage (T3 vs. T2, OR:11.332, 95% CI:3.929-32.681, p < 0.001; T4 vs. T2, OR:9.101, 95% CI:1.962-42.213, p = 0.005), with corresponding optimal cutoff values of 2.3 (area under the curve [AUC]: 0.873, sensitivity: 0.736, specificity: 0.902), 1.72 (AUC: 0.558, sensitivity: 0.529, specificity: 0.643), 83.305 (AUC: 0.651, sensitivity: 0.299, specificity: 0.979), and 21.875 (AUC: 0.672, sensitivity: 0.736, specificity: 0.601). Subsequent nomogram construction was associated with good predictive ability, with a C-index of 0.887(95% CI: 0.793-0.981) and an AUC of 0.924 (95% CI: 0.882-0.965). CONCLUSION SUVmax, the neutrophil-lymphocyte ratio, the platelet-lymphocyte ratio, initial TPSA, and clinical T-stage represent valuable independent predictors of lymph node metastasis in prostate cancer patients, offering an opportunity to further optimize lymph node staging for these patients.
Collapse
Affiliation(s)
| | - Yongxiang Tang
- Department of Nuclear Medicine, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China
| | - Xiaomei Gao
- Department of Pathology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China
| | - Yu Gan
- Department of Urology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China
| | - Shuo Hu
- Department of Nuclear Medicine, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China
| | - Min-Feng Chen
- Department of Urology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China
| | - Yi Cai
- Department of Urology, Disorders of Prostate Cancer Multidisciplinary Team, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China
| |
Collapse
|
24
|
Validating the screening criteria for bone metastases in treatment-naïve unfavorable intermediate and high-risk prostate cancer - the prevalence and location of bone- and lymph node metastases. Eur Radiol 2022; 32:8266-8275. [PMID: 35939081 DOI: 10.1007/s00330-022-08945-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/12/2022] [Accepted: 05/30/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The European Association of Urology (EAU) recommends a bone scan for newly diagnosed unfavorable intermediate- and high-risk prostate cancer. We aimed to validate the screening criteria for bone metastases in patients with treatment-naïve prostate cancer. METHODS This single-center retrospective study included all patients with treatment-naïve unfavorable intermediate- or high-risk prostate cancer. All underwent MRI of the lumbar column (T2Dixon) and pelvis (3DT2w, DWI, and T2 Dixon). The presence and location of lymph node and bone metastases were registered according to risk groups and radiological (rad) T-stage. The risk of lymph node metastases was assessed by odds ratio (OR). RESULTS We included 390 patients, of which 68% were high-risk and 32% were unfavorable intermediate-risk. In the high-risk group, the rate of regional- and non-regional lymph node metastases was 11% and 6%, respectively, and the rate of bone metastases was 10%. In the unfavorable intermediate-risk group, the rate of regional- and non-regional lymph node metastases was 4% and 0.8%, respectively, and the rate of bone metastases was 0.8%. Metastases occurred exclusively in the lumbar column in 0.5% of all patients, in the pelvis in 4%, and the pelvis and lumbar column in 3%. All patients with bone metastases had radT3-4, and patients with radT3-4 showed a four-fold increased risk of lymph node metastases (OR 4.48, 95% CI: 2.1-9.5). CONCLUSION Bone metastases were found in 10% with high-risk prostate cancer and 0.8% with unfavorable intermediate-risk. Therefore, we question the recommendation to screen the unfavorable intermediate-risk group for bone metastases. KEY POINTS • The rate of bone metastases was 10% in high-risk patients and 0.8% in the unfavorable intermediate-risk group. • The rate of lymph-node metastases was 17% in high-risk patients and 5% in the unfavorable intermediate-risk group. • No bone metastases were seen in radiologically localized disease.
Collapse
|
25
|
Miro-Padovani M, Batista da Costa J, Salomon L, Ingels A, De la Taille A. [High risk localized and locally advanced prostate cancer: Long-term oncological outcomes after prostatectomy]. Prog Urol 2022; 32:702-710. [PMID: 35773175 DOI: 10.1016/j.purol.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 03/21/2022] [Accepted: 04/28/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION High risk localized and locally advanced forms are responsible for the vast majority of specific deaths from prostate cancer among non-metastatic diseases at diagnosis. No randomized study has yet been published to establish the best local treatment in terms of survival. AIM Conduct a large-volume cohort study with long-term follow-up to analyze specific and overall survival outcomes after surgery. METHOD A single-center retrospective study of all patients operated on for localized high-risk and locally advanced prostate cancer was performed. Actuarial survival analyses and multivariate analyses were performed to discern predictive risk factors. RESULTS Five hundred patients were included. MRI stage was≥iT3a in 40.7% of cases and 50.2% of patients had a Gleason score≥8 on biopsy. The mean follow-up was 63.1 months. The overall, specific and biological recurrence-free survival were respectively 77.6%, 93.9% and 26.8% at 10 years. A PSA level≥20, a Gleason score on biopsy≥9 and a MRI stage≥iT3a were significantly associated with the 10-years biological recurrence risk. CONCLUSION This study shows very good long-term oncological results. In the absence of a randomized controlled trial, these results suggest the primary role of surgery in this indication and support the evolution of current practices. We pointed out very pejorative features that might help selection of the best candidates for surgical treatment. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- M Miro-Padovani
- Service d'urologie et de transplantation rénale, faculté de médecine Paris 12, CHU d'Henri-Mondor, 51, avenue Marechal-de-Lattre-de-Tassigny, 94000 Créteil, France.
| | - J Batista da Costa
- Service d'urologie et de transplantation rénale, faculté de médecine Paris 12, CHU d'Henri-Mondor, 51, avenue Marechal-de-Lattre-de-Tassigny, 94000 Créteil, France.
| | - L Salomon
- Service d'urologie, centre hospitalier Mont-de-Marsan, 417, avenue Pierre-de-Coubertin, 40024 Mont-de-Marsan, France.
| | - A Ingels
- Service d'urologie et de transplantation rénale, faculté de médecine Paris 12, CHU d'Henri-Mondor, 51, avenue Marechal-de-Lattre-de-Tassigny, 94000 Créteil, France.
| | - A De la Taille
- Service d'urologie et de transplantation rénale, faculté de médecine Paris 12, CHU d'Henri-Mondor, 51, avenue Marechal-de-Lattre-de-Tassigny, 94000 Créteil, France.
| |
Collapse
|
26
|
Arslan A, Karaarslan E, Güner AL, Sağlıcan Y, Tuna MB, Kural AR. Comparing the Diagnostic Performance of Multiparametric Prostate MRI Versus 68Ga-PSMA PET-CT in the Evaluation Lymph Node Involvement and Extraprostatic Extension. Acad Radiol 2022; 29:698-704. [PMID: 32768351 DOI: 10.1016/j.acra.2020.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/27/2020] [Accepted: 07/05/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE Our research aims to compare the efficacy of PET and MRI for lymph node metastasis and extraprostatic extension in cases with newly diagnosed prostate cancer undergoing radical prostatectomy with extended pelvic lymph node dissection. METHODS Thirty-nine cases who underwent radical prostatectomy with pelvic lymph node dissection between June 2015 and January 2020 were included in the study. Patients with gallium (ga-68 Prostate-specific membrane antigen (PSMA) PET) PSMA PET-CT and multiparametric (mp) prostate MRI performed according to PIRADS v2 criteria in our clinic were included. RESULTS The extraprostatic extension was observed in 16 cases. The sensitivity of MR in detecting extracapsular invasion was calculated as 56.2%, specificity 82.6%, positive predictive value (PPV) 69.2%, negative predictive value (NPV) 73.0%. The sensitivity of PET was 62.5%, specificity 60.8%, PPV 52.6%, NPV 70%. Eleven lymph node metastases were observed in nine cases. The sensitivity, specificity, PPV and NPV of metastatic lymph node detection were; 36.3%, 99.6%, 57.1%, 99.0% for MRI and; 18.1%, 99.4%, 33.3%, 98.8% for PET CT, respectively. CONCLUSION Mp prostate MRI showed low sensitivity and high specificity compared to PSMA PET CT in extracapsular invasion evaluation. The sensitivity of both modalities in the detection of metastatic lymph nodes was low.
Collapse
|
27
|
Caglic I, Sushentsev N, Colarieti A, Warren AY, Shah N, Lamb BW, Barrett T. Value of the capsular enhancement sign on dynamic contrast-enhanced prostate multiparametric MRI for the detection of extracapsular extension. Eur J Radiol 2022; 150:110275. [DOI: 10.1016/j.ejrad.2022.110275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/14/2022] [Accepted: 03/20/2022] [Indexed: 01/10/2023]
|
28
|
Michael J, Neuzil K, Altun E, Bjurlin MA. Current Opinion on the Use of Magnetic Resonance Imaging in Staging Prostate Cancer: A Narrative Review. Cancer Manag Res 2022; 14:937-951. [PMID: 35256864 PMCID: PMC8898014 DOI: 10.2147/cmar.s283299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/10/2022] [Indexed: 12/02/2022] Open
Abstract
Accurate staging is critical for treatment planning and prognosis in men with prostate Cancer. Prostate magnetic imaging resonance (MRI) may aid in the staging evaluation by verifying organ-confined status, assessing the status of the pelvic lymph nodes, and establishing the local extent of the tumor in patients being considered for therapy. MRI has a high specificity for diagnosing extracapsular extension, and therefore may impact the decision to perform nerve sparing prostatectomy, along with seminal vesicle invasion and lymph node metastases; however, its sensitivity remains limited. Current guidelines vary significantly regarding endorsing the use of MRI for staging locoregional disease. For high-risk prostate cancer, most guidelines recommend cross sectional imaging, including MRI, to evaluate for more extensive disease that may merit change in radiation field, extended androgen deprivation therapy, or guiding surgical planning. Although MRI offers reasonable performance characteristics to evaluate bone metastases, guidelines continue to support the use of bone scintigraphy. Emerging imaging technologies, including coupling positron emission tomography (PET) with MRI, have the potential to improve the accuracy of prostate cancer staging with the use of novel radiotracers.
Collapse
Affiliation(s)
- Jamie Michael
- University of North Carolina, School of Medicine, Chapel Hill, NC, USA
| | - Kevin Neuzil
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ersan Altun
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marc A Bjurlin
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Correspondence: Marc A Bjurlin, Associate Professor, Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, 2nd Floor, Chapel Hill, NC, USA, Email
| |
Collapse
|
29
|
Frego N, Paciotti M, Buffi NM, Maffei D, Contieri R, Avolio PP, Fasulo V, Uleri A, Lazzeri M, Hurle R, Saita A, Guazzoni GF, Casale P, Lughezzani G. External Validation and Comparison of Two Nomograms Predicting the Probability of Lymph Node Involvement in Patients subjected to Robot-Assisted Radical Prostatectomy and Concomitant Lymph Node Dissection: A Single Tertiary Center Experience in the MRI-Era. Front Surg 2022; 9:829515. [PMID: 35284478 PMCID: PMC8913721 DOI: 10.3389/fsurg.2022.829515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionTo externally validate and directly compare the performance of the Briganti 2012 and Briganti 2019 nomograms as predictors of lymph node invasion (LNI) in a cohort of patients treated with robot-assisted radical prostatectomy (RARP) and extended pelvic lymph node dissection (ePLND).Materials and MethodsAfter the exclusion of patients with incomplete biopsy, imaging, or clinical data, 752 patients who underwent RARP and ePLND between December 2014 to August 2021 at our center, were included. Among these patients, 327 (43.5%) had undergone multi-parametric MRI (mpMRI) and mpMRI-targeted biopsy. The preoperative risk of LNI was calculated for all patients using the Briganti 2012 nomogram, while the Briganti 2019 nomogram was used only in patients who had performed mpMRI with the combination of targeted and systematic biopsy. The performances of Briganti 2012 and 2019 models were evaluated using the area under the receiver-operating characteristics curve analysis, calibrations plot, and decision curve analysis.ResultsA median of 13 (IQR 9–18) nodes per patient was removed, and 78 (10.4%) patients had LNI at final pathology. The area under the curves (AUCs) for Briganti 2012 and 2019 were 0.84 and 0.82, respectively. The calibration plots showed a good correlation between the predicted probabilities and the observed proportion of LNI for both models, with a slight tendency to underestimation. The decision curve analysis (DCA) of the two models was similar, with a slightly higher net benefit for Briganti 2012 nomogram. In patients receiving both systematic- and targeted-biopsy, the Briganti 2012 accuracy was 0.85, and no significant difference was found between the AUCs of 2012 and 2019 nomograms (p = 0.296). In the sub-cohort of 518 (68.9%) intermediate-risk PCa patients, the Briganti 2012 nomogram outperforms the 2019 model in terms of accuracy (0.82 vs. 0.77), calibration curve, and net benefit at DCA.ConclusionThe direct comparison of the two nomograms showed that the most updated nomogram, which included MRI and MRI-targeted biopsy data, was not significantly more accurate than the 2012 model in the prediction of LNI, suggesting a negligible role of mpMRI in the current population.
Collapse
Affiliation(s)
- Nicola Frego
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Marco Paciotti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Davide Maffei
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Roberto Contieri
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Pier Paolo Avolio
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Vittorio Fasulo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Alessandro Uleri
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Massimo Lazzeri
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Rodolfo Hurle
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Alberto Saita
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Giorgio Ferruccio Guazzoni
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Paolo Casale
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
- *Correspondence: Giovanni Lughezzani
| |
Collapse
|
30
|
Caglic I, Sushentsev N, Shah N, Warren AY, Lamb BW, Barrett T. Integration of Prostate Biopsy Results with Pre-Biopsy Multiparametric Magnetic Resonance Imaging Findings Improves Local Staging of Prostate Cancer. Can Assoc Radiol J 2022; 73:515-523. [PMID: 35199583 DOI: 10.1177/08465371211073158] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To assess the added value of histological information for local staging of prostate cancer (PCa) by comparing the accuracy of multiparametric MRI alone (mpMRI) and mpMRI with biopsy Gleason grade (mpMRI+Bx). METHODS 133 consecutive patients who underwent preoperative 3T-MRI and subsequent radical prostatectomy for PCa were included in this single-centre retrospective study. mpMRI imaging was reviewed independently by two uroradiologists for the presence of extracapsular extension (ECE) and seminal vesicle invasion (SVI) on a 5-point Likert scale. For second reads, the radiologists received results of targeted fused MR/US biopsy (mpMRI+Bx) prior to re-staging. RESULTS The median patient age was 63 years (interquartile range (IQR) 58-67 years) and median PSA was 6.5 ng/mL (IQR 5.0-10.0 ng/mL). Extracapsular extension was present in 85/133 (63.9%) patients and SVI was present in 22/133 (16.5%) patients. For ECE prediction, mpMRI showed sensitivity and specificity of 63.5% and 81.3%, respectively, compared to 77.7% and 81.3% achieved by mpMRI+Bx. At an optimal cut-off value of Likert score ≥ 3, areas under the curves (AUCs) was .85 for mpMRI+Bx and .78 for mpMRI, P < .01. For SVI prediction, AUC was .95 for mpMRI+Bx compared to .92 for mpMRI; P = .20. Inter-reader agreement for ECE and SVI prediction was substantial for mpMRI (k range, .78-.79) and mpMRI+Bx (k range, .74-.79). CONCLUSIONS MpMRI+Bx showed superior diagnostic performance with an increased sensitivity for ECE prediction but no significant difference for SVI prediction. Inter-reader agreement was substantial for both protocols. Integration of biopsy information adds value when staging prostate mpMRI.
Collapse
Affiliation(s)
- Iztok Caglic
- CamPARI Prostate Cancer Group, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Radiology, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Faculty of Medicine, University of Ljubljana, Slovenia
| | - Nikita Sushentsev
- Department of Radiology, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Nimish Shah
- CamPARI Prostate Cancer Group, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Urology, 573020Addenbrooke's Hospital, Cambridge, UK
| | - Anne Y Warren
- CamPARI Prostate Cancer Group, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Pathology, 573020Addenbrooke's Hospital, Cambridge, UK
| | - Benjamin W Lamb
- CamPARI Prostate Cancer Group, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Urology, 573020Addenbrooke's Hospital, Cambridge, UK
| | - Tristan Barrett
- CamPARI Prostate Cancer Group, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Radiology, 573020Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| |
Collapse
|
31
|
Valentin B, Arsov C, Ullrich T, Demetrescu D, Morawitz J, Al-Monajjed R, Quentin M, Kirchner J, Esposito I, Albers P, Antoch G, Schimmöller L. Comparison of 3 T mpMRI and pelvic CT examinations for detection of lymph node metastases in patients with prostate cancer. Eur J Radiol 2022; 147:110110. [DOI: 10.1016/j.ejrad.2021.110110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/19/2021] [Accepted: 12/12/2021] [Indexed: 01/21/2023]
|
32
|
Keshav N, Ehrhart MD, Eberhardt SC, Terrazas MF. Local Staging of Prostate Cancer with Multiparametric MRI. Semin Roentgenol 2021; 56:366-375. [PMID: 34688339 DOI: 10.1053/j.ro.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Nandan Keshav
- Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Mark D Ehrhart
- Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Steven C Eberhardt
- Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, NM.
| | - Martha F Terrazas
- Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, NM
| |
Collapse
|
33
|
Schlemmer HP, Krause BJ, Schütz V, Bonekamp D, Schwarzenböck S, Hohenfellner M. Imaging of Prostate Cancer. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:713-719. [PMID: 34427180 DOI: 10.3238/arztebl.m2021.0309] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/06/2021] [Accepted: 07/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Prostate cancer is the most common type of solid tumor in men and the second most common cause of cancer-related death in males in Germany. The conventional strategy for its primary detection, i.e., systematic ultrasound-guided prostate biopsy in men who have elevated PSA levels and/or positive findings on digital rectal examination, fails to reveal all cases. The same is true of the use of conventional computed tomography (CT), magnetic resonance imaging (MRI), and skeletal scintigraphy for the early detection of recurrences and distant metastases. METHODS This review is based on pertinent publications retrieved by a selective search, including the German clinical practice guideline on prostate cancer and systematic review articles. RESULTS Prospective multicenter trials have shown that the detection of clinically significant prostate cancer is markedly improved with multiparametric MRI (mpMRI) and MR/TRUS fusion biopsy (TRUS = transrectal ultrasonography), compared to conventional systematic biopsy. A recent Cochrane review showed that the rate of overdiagnosis of low-risk prostate cancer was reduced with mpMRI and MR/TRUS fusion biopsy compared with conventional systematic biopsy (95/1000 vs. 139/1000), and that clinically significant prostate cancer was more reliably detected (sensitivity 72% vs. 63%), albeit with slightly lower specificity (96% vs. 100%). Prostate-specific membrane antigen (PSMA) hybrid imaging improves the detection of lymphogenic and bony metastases in patients with high-risk prostate cancer. PSMA hybrid imaging is most commonly used to detect biochemical recurrences. A meta-analysis showed that the detection rate depends on the PSA concentration: 74.1% overall, 33.7% with PSA <0.2 ng/mL, and 91.7% with PSA ≥ 2.0 ng/mL. CONCLUSION The appropriate use of mpMRI and MR/TRUS fusion biopsy improves the initial detection of prostate cancer as well as the assessment of the prognosis. PSMA hybrid imaging is useful for the staging of high-risk patients and for the detection of recurrences. These methods are now recommended in the German clinical practice guideline on prostate cancer as well as in guidelines from other countries.
Collapse
|
34
|
Ling SW, de Jong AC, Schoots IG, Nasserinejad K, Busstra MB, van der Veldt AAM, Brabander T. Comparison of 68Ga-labeled Prostate-specific Membrane Antigen Ligand Positron Emission Tomography/Magnetic Resonance Imaging and Positron Emission Tomography/Computed Tomography for Primary Staging of Prostate Cancer: A Systematic Review and Meta-analysis. EUR UROL SUPPL 2021; 33:61-71. [PMID: 34632423 PMCID: PMC8488242 DOI: 10.1016/j.euros.2021.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/25/2022] Open
Abstract
Context In December 2020, the US Food and Drug Administration approved a 68Ga-labeled prostate-specific membrane antigen ligand (68Ga-PSMA-11) for positron emission tomography (PET) in patients with suspected prostate cancer (PCa) metastasis who are candidates for initial definitive therapy. 68Ga-PSMA PET is increasingly performed for these patients and is usually combined with computed tomography (CT). In recent years, 68Ga-PSMA PET has been combined with high-resolution magnetic resonance imaging (MRI), which is beneficial for T staging and may further enhance the staging of primary PCa. Objective To compare the diagnostic accuracy of 68Ga-PSMA PET/MRI with 68Ga-PSMA PET/CT for staging of primary PCa. Evidence acquisition A comprehensive literature search was performed using Embase, PubMed/Medline, Web of Science, Cochrane Library, and Google Scholar up to June 24, 2021 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using the QUADAS-2 tool. Evidence synthesis The search identified 2632 articles, of which 27 were included. The diagnostic accuracy of 68Ga-PSMA PET/MRI, measured as the pooled natural logarithm of diagnostic odds ratio (lnDOR), was 2.27 (95% confidence interval [CI] 1.21–3.32) for detection of extracapsular extension (ECE), 3.50 (95% CI 2.14–4.86) for seminal vesicle invasion (SVI), and 4.73 (95% CI 2.93–6.52) for lymph node metastasis (LNM). For 68Ga-PSMA PET/CT, the analysis showed lnDOR of 2.45 (95% CI 0.75–4.14), 2.94 (95% CI 2.26–3.63), and 2.42 (95% CI 2.07–2.78) for detection of ECE, SVI, and LNM, respectively. The overall risk of bias and applicability concerns were assessed as moderate and low, respectively. Conclusions 68Ga-PSMA PET/MRI shows high diagnostic accuracy equivalent to that of 68Ga-PSMA PET/CT for detection of ECE, SVI, and LNM in staging of PCa. There is an urgent need for direct comparison of the two diagnostic tests in future research. Patient summary The use of radioactively labeled molecules that bind to prostate-specific membrane antigen (68Ga-PSMA) for positron emission tomography (PET) scans combined with either computed tomography (CT) or magnetic resonance imaging (MRI) is increasing for prostate cancer diagnosis. There is a need for direct comparison of the two tests to demonstrate the benefit of 68Ga-PSMA PET/MRI for determining tumor stage in prostate cancer. Take Home Message After the recent US Food and Drug Administration approval of 68Ga-labeled prostate-specific membrane antigen ligand (68Ga-PSMA) positron emission tomography (PET) for staging of primary prostate cancer (PCa), it is expected that the use of this imaging modality will increase rapidly. Our review of the literature shows that 68Ga-PSMA PET/magnetic resonance imaging has high diagnostic accuracy equivalent to that of 68Ga-PSMA PET/computed tomography in primary PCa staging. There is an urgent need for direct head-to-head comparison of the two diagnostic tests in future research.
Collapse
Affiliation(s)
- Sui Wai Ling
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Anouk C de Jong
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.,Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Astrid A M van der Veldt
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.,Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Tessa Brabander
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| |
Collapse
|
35
|
Bura V, Caglic I, Snoj Z, Sushentsev N, Berghe AS, Priest AN, Barrett T. MRI features of the normal prostatic peripheral zone: the relationship between age and signal heterogeneity on T2WI, DWI, and DCE sequences. Eur Radiol 2021; 31:4908-4917. [PMID: 33398421 PMCID: PMC8213603 DOI: 10.1007/s00330-020-07545-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/30/2020] [Accepted: 11/18/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To assess the multiparametric MRI (mpMRI) appearances of normal peripheral zone (PZ) across age groups in a biopsy-naïve population, where prostate cancer (PCa) was subsequently excluded, and propose a scoring system for background PZ changes. METHODS This retrospective study included 175 consecutive biopsy-naïve patients (40-74 years) referred with a suspicion of PCa, but with subsequent negative investigations. Patients were grouped by age into categories ≤ 54, 55-59, 60-64, and ≥ 65 years. MpMRI sequences (T2-weighted imaging [T2WI], diffusion-weighted imaging [DWI]/apparent diffusion coefficient [ADC], and dynamic contrast-enhanced imaging [DCE]) were independently evaluated by two uro-radiologists on a proposed 4-point grading scale for background change on each sequence, wherein score 1 mirrored PIRADS-1 change and score 4 represented diffuse background change. Peripheral zone T2WI signal intensity and ADC values were also analyzed for trends relating to age. RESULTS There was a negative correlation between age and assigned background PZ scores for each mpMRI sequence: T2WI: r = - 0.52, DWI: r = - 0.49, DCE: r = - 0.45, p < 0.001. Patients aged ≤ 54 years had mean scores of 3.0 (T2WI), 2.7 (DWI), and 3.1 (DCE), whilst patients ≥ 65 years had significantly lower mean scores of 1.7, 1.4, and 1.9, respectively. There was moderate inter-reader agreement for all scores (range κ = 0.43-0.58). Statistically significant positive correlations were found for age versus normalized T2WI signal intensity (r = 0.2, p = 0.009) and age versus ADC values (r = 0.33, p = 0.001). CONCLUSION The normal PZ in younger patients (≤ 54 years) demonstrates significantly lower T2WI signal intensity, lower ADC values, and diffuse enhancement on DCE, which may hinder diagnostic interpretation in these patients. The proposed standardized PZ background scoring system may help convey the potential for diagnostic uncertainty to clinicians. KEY POINTS • Significant, positive correlations were found between increasing age and higher normalized T2-weighted signal intensity and mean ADC values of the prostatic peripheral zone. • Younger men exhibit lower T2-weighted imaging signal intensity, lower ADC values, and diffuse enhancement on dynamic contrast-enhanced imaging, which may hinder MRI interpretation. • A scoring system is proposed which aims towards a standardized assessment of the normal background PZ. This may help convey the potential for diagnostic uncertainty to clinicians.
Collapse
Affiliation(s)
- Vlad Bura
- Department of Radiology, County Clinical Emergency Hospital, Cluj-Napoca, Cluj, Romania
| | - Iztok Caglic
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Hills Road, Cambridge, CB2 0QQ, UK
| | - Ziga Snoj
- Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Hills Road, Cambridge, CB2 0QQ, UK
| | - Alexandra S Berghe
- Department of Radiology, County Clinical Emergency Hospital, Cluj-Napoca, Cluj, Romania
- Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andrew N Priest
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Hills Road, Cambridge, CB2 0QQ, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Box 218, Hills Road, Cambridge, CB2 0QQ, UK.
| |
Collapse
|
36
|
Toby J, Eade T, Hruby G, Kneebone A, Aherne N, Brown C, Guo L, Hoffmann M, Shakespeare TP. Assessing ISUP prostate cancer grade groups in patients treated with definitive dose escalated external beam radiation. Radiother Oncol 2021; 162:91-97. [PMID: 34171454 DOI: 10.1016/j.radonc.2021.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The five grade group system has been validated for men treated with radical prostatectomy. However, the prognostic value for men treated with radiation therapy is uncertain, with prior studies utilising old techniques and doses. We aimed to validate the International Society of Urological Pathology (ISUP) groupings for men treated with contemporary radiation therapy. METHODS Men with localised prostate cancer treated with image-guided, dose-escalated (≥78 Gy) external beam radiation were identified across four institutions. Primary outcome was time to biochemical failure. Harrell's C index assessed performance of the ISUP system against other grading stratifications. RESULTS 2205 men were included, withmedian follow-up of 5.6 years. Seven-year actuarial rates of biochemical failure for grade groups 1-5 were 9.3%, 10.4%, 13.2%, 12.4% and 23.4%. On multivariate analysis, hazard ratios for biochemical failure were1.19, 1.00, 1.10, 1.05 and 2.10 for grade groups 1-5, relative to 2. P values were only significant for grade group 5. Harrell's C index favoured an alternative three group model (comprising Gleason scores [6 and 3 + 4 = 7] vs [4 + 3 = 7 and 8] vs [9 and 10]) over ISUP grade groups. CONCLUSIONS The ISUP grade groups were not validated in a contemporary cohort treated with dose-escalated, image-guided radiation therapy. Grade groups 1-4 were not statistically different from each other; however, grade group 5 had a significantly worse prognosis. We identified a new three group model that better predicted biochemical outcomes. Further work is requiredto validate optimal groupings for modern radiation therapy and investigate the contrasting prognostic capability of grade groups in surgical and radiation therapy patients.
Collapse
Affiliation(s)
| | - Thomas Eade
- Central Coast Cancer Centre, Gosford, Australia; Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Australia; University of Sydney Northern Clinical School, Kolling Building Level 7, Royal North Shore Hospital, St Leonards, Australia
| | - George Hruby
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Australia; University of Sydney Northern Clinical School, Kolling Building Level 7, Royal North Shore Hospital, St Leonards, Australia
| | - Andrew Kneebone
- Central Coast Cancer Centre, Gosford, Australia; Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Australia; University of Sydney Northern Clinical School, Kolling Building Level 7, Royal North Shore Hospital, St Leonards, Australia
| | - Noel Aherne
- Mid North Coast Cancer Institute Coffs Harbour, Coffs Harbour Health Campus, Coffs Harbour, Australia
| | - Chris Brown
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Australia; National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Lesley Guo
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Australia
| | - Matthew Hoffmann
- Mid North Coast Cancer Institute Port Macquarie, Port Macquarie Health Campus, Port Macquarie, Australia
| | - Thomas P Shakespeare
- Mid North Coast Cancer Institute Coffs Harbour, Coffs Harbour Health Campus, Coffs Harbour, Australia; Mid North Coast Cancer Institute Port Macquarie, Port Macquarie Health Campus, Port Macquarie, Australia; North Coast Cancer Institute, Lismore Cancer Care and Haematology Unit, Ground Floor, Lismore, Australia
| |
Collapse
|
37
|
Colarieti A, Thiruchelvam N, Barrett T. Evaluation of image-based prognostic parameters of post-prostatectomy urinary incontinence: A literature review. Int J Urol 2021; 28:890-897. [PMID: 34101272 DOI: 10.1111/iju.14609] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/04/2021] [Indexed: 12/18/2022]
Abstract
Prostate cancer is the second most common male cancer, and radical prostatectomy is a highly effective treatment for intermediate and high-risk disease. However, post-prostatectomy urinary incontinence remains a major functional side-effect in patients undergoing radical prostatectomy. Despite recent improvements in preoperative imaging quality and surgical techniques, it remains challenging to predict or prevent occurrence of this complication. The aim of this research was to review the current published literature on pre- and postoperative imaging evaluation of the prostate and pelvic structures, to identify added value in the prediction of post-prostatectomy urinary incontinence. A computerized bibliographic search of the PubMed library was carried out to identify imaging-based articles evaluating the pelvic floor and surrounding structures pre- and/or postradical prostatectomy to predict post-prostatectomy urinary incontinence. A total of 32 articles were included. Of these, 29 papers assessed the importance of magnetic resonance imaging evaluation, with a total of 16 parameters evaluated. The most common parameters were intravesical protrusion, the membranous urethral length, prostatic volume and periurethral fibrosis. Preoperative membranous urethral length and its preservation after surgery showed the strongest correlation with urinary incontinence. Three studies evaluated ultrasound, with all carried out postoperatively. This technique benefits from a dynamic evaluation, and the results are promising for proximal urethral hypermobility and the degree of bladder neck funneling on the Valsalva maneuver. Several imaging studies evaluated the predictors of post-prostatectomy urinary incontinence, with preoperative membranous urethral length offering the most promise. However, the current literature is limited by the single-center nature of studies, and the heterogeneity in patient populations and methodologies used.
Collapse
Affiliation(s)
- Anna Colarieti
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Nikesh Thiruchelvam
- Department of, Urology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Tristan Barrett
- Department of, Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.,CamPARI Clinic, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| |
Collapse
|
38
|
Valentin B, Schimmöller L, Ullrich T, Klingebiel M, Demetrescu D, Sawicki LM, Lakes J, Mally D, Quentin M, Esposito I, Albers P, Antoch G, Arsov C. Magnetic resonance imaging improves the prediction of tumor staging in localized prostate cancer. Abdom Radiol (NY) 2021; 46:2751-2759. [PMID: 33452898 PMCID: PMC8205913 DOI: 10.1007/s00261-020-02913-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The aim of this study was to investigate 3 Tesla multiparametric magnetic resonance imaging (mpMRI)-based predictors for the pretherapeutic T staging of prostate cancer and their accuracy. METHODS Consecutive patients with 3 Tesla mpMRI, positive systematic and MR-targeted biopsy, and subsequent radical prostatectomy (RPE) between 01/2016 and 12/2017 were included. MRI parameters such as measurable extraprostatic extension (EPE) (≥ 3 mm), length of (pseudo)capsular contact (LCC), invasion of neurovascular bundle (NVBI), and/or seminal vesicles lesion contact (SVC) or infiltration (SVI) were assessed and correlated to clinical and histopathological results. RESULTS 136 men were included. In 76 cases, a pT2 stage was determined, in 29 cases a pT3a, and in 31 a pT3b stage. The positive and negative predictive values (PPV, NPV) for the detection of T3 by measurable EPE on MRI was 98% (CI 0.88-1) and 81% (CI 0.72-0.87). No visible NVBI was found in pT2 patients (NPV 100%; CI 0.95-1). ROC analysis for T3a prediction with LCC (AUC 0.81) showed a sensitivity of 87% and a specificity of 62% at a threshold of 12.5 mm (J = 0.485) and 93% and 58% at 11 mm (Jmax = 0.512). All patients with pT3a had a LCC > 5 mm. In case of pT3b, 29/31 patients showed a SVC (PPV 76%, CI 0.61-0.87; NPV 98%, CI 0.93-0.99), and 23/31 patients showed a SVI (PPV 100%, CI 0.86-1; NPV 93%, CI 0.87-0.96). EPE (p < 0.01), LCC (p = 0.05), and SVC (p = 0.01) were independent predictors of pT3. CONCLUSIONS MRI-measurable EPE, LCC, and SVC were reliable, independent, preoperative predictors for a histopathological T3 stage. A LCC ≥ 11 mm indicated a pT3a stage, whereas a LCC < 5 mm excluded it. On MRI, visible SVI or even SVC of the PCa lesion was reliable preoperative predictors for a pT3b stage.
Collapse
Affiliation(s)
- B. Valentin
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225 Dusseldorf, Germany
| | - L. Schimmöller
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225 Dusseldorf, Germany
| | - T. Ullrich
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225 Dusseldorf, Germany
| | - M. Klingebiel
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225 Dusseldorf, Germany
| | - D. Demetrescu
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225 Dusseldorf, Germany
| | - L. M. Sawicki
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225 Dusseldorf, Germany
| | - J. Lakes
- Department of Urology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225 Dusseldorf, Germany
| | - D. Mally
- Department of Urology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225 Dusseldorf, Germany
| | - M. Quentin
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225 Dusseldorf, Germany
| | - I. Esposito
- Department of Pathology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany
| | - P. Albers
- Department of Urology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225 Dusseldorf, Germany
| | - G. Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225 Dusseldorf, Germany
| | - C. Arsov
- Department of Urology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225 Dusseldorf, Germany
| |
Collapse
|
39
|
Caglic I, Sushentsev N, Shah N, Warren AY, Lamb BW, Barrett T. Comparison of biparametric versus multiparametric prostate MRI for the detection of extracapsular extension and seminal vesicle invasion in biopsy naïve patients. Eur J Radiol 2021; 141:109804. [PMID: 34062473 DOI: 10.1016/j.ejrad.2021.109804] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/22/2021] [Accepted: 05/26/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare biparametric MRI (bpMRI) with multiparametric MRI (mpMRI) staging accuracy in assessing extracapsular extension (ECE) and seminal vesicle invasion (SVI). METHOD Biopsy-naïve patients undergoing 3 T-MRI before radical prostatectomy for clinically significant prostate cancer were included in this single-centre retrospective study. Two uroradiologists separately evaluated bpMRI and mpMRI for presence of ECE and SVI using a 5-point Likert scale (1: ECE/SVI highly unlikely, 5: ECE/SVI highly likely). RESULTS 110 men of median age 63 years and PSA 8.5 ng/mL were included. ECE and SVI was confirmed histologically in 71/110 (64.5 %) and 18/110 (16.4 %) patients, respectively. Sensitivity and specificity of bpMRI versus mpMRI for predicting ECE was 59.1 % and 87.2 % versus 66.2 % and 84.6 %, respectively. For SVI detection, the sensitivity and specificity for bpMRI versus mpMRI was 66.7 % and 92.4 % versus 83.3 % and 97.8 %, respectively. At an optimal cut-off Likert score ≥3 for ECE prediction, mpMRI area under the receiver operating curve (AUC) was 0.80 (95 % confidence interval (CI) 0.72-0.87) versus 0.78 (95 % CI 0.69-0.86) for bpMRI (p = 0.52) and for SVI, mpMRI AUC was 0.91 (95 % CI 0.84-0.96) versus 0.86 (95 % CI 0.78-0.92) for bpMRI (p = 0.02), respectively. Inter-reader agreement for both ECE and SVI prediction was substantial, with a marginally higher k-value for mpMRI (k range, 0.67-0.75) than bpMRI (k range, 0.65-0.69). CONCLUSIONS Diagnostic performance of bpMRI and mpMRI was comparable for detection of ECE, however, mpMRI with contrast was superior for SVI detection and improved the inter-reader agreement.
Collapse
Affiliation(s)
- Iztok Caglic
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| | - Nimish Shah
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Urology, Addenbrooke's Hospital, Cambridge, UK.
| | - Anne Y Warren
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Pathology, Addenbrooke's Hospital, Cambridge, UK.
| | - Benjamin W Lamb
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Urology, Addenbrooke's Hospital, Cambridge, UK.
| | - Tristan Barrett
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| |
Collapse
|
40
|
Caglic I, Sushentsev N, Gnanapragasam VJ, Sala E, Shaida N, Koo BC, Kozlov V, Warren AY, Kastner C, Barrett T. MRI-derived PRECISE scores for predicting pathologically-confirmed radiological progression in prostate cancer patients on active surveillance. Eur Radiol 2021; 31:2696-2705. [PMID: 33196886 PMCID: PMC8043947 DOI: 10.1007/s00330-020-07336-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 06/16/2020] [Accepted: 07/23/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To assess the predictive value and correlation to pathological progression of the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) scoring system in the follow-up of prostate cancer (PCa) patients on active surveillance (AS). METHODS A total of 295 men enrolled on an AS programme between 2011 and 2018 were included. Baseline multiparametric magnetic resonance imaging (mpMRI) was performed at AS entry to guide biopsy. The follow-up mpMRI studies were prospectively reported by two sub-specialist uroradiologists with 10 years and 13 years of experience. PRECISE scores were dichotomized at the cut-off value of 4, and the sensitivity, specificity, positive predictive value and negative predictive value were calculated. Diagnostic performance was further quantified by using area under the receiver operating curve (AUC) which was based on the results of targeted MRI-US fusion biopsy. Univariate analysis using Cox regression was performed to assess which baseline clinical and mpMRI parameters were related to disease progression on AS. RESULTS Progression rate of the cohort was 13.9% (41/295) over a median follow-up of 52 months. With a cut-off value of category ≥ 4, the PRECISE scoring system showed sensitivity, specificity, PPV and NPV for predicting progression on AS of 0.76, 0.89, 0.52 and 0.96, respectively. The AUC was 0.82 (95% CI = 0.74-0.90). Prostate-specific antigen density (PSA-D), Likert lesion score and index lesion size were the only significant baseline predictors of progression (each p < 0.05). CONCLUSION The PRECISE scoring system showed good overall performance, and the high NPV may help limit the number of follow-up biopsies required in patients on AS. KEY POINTS • PRECISE scores 1-3 have high NPV which could reduce the need for re-biopsy during active surveillance. • PRECISE scores 4-5 have moderate PPV and should trigger either close monitoring or re-biopsy. • Three baseline predictors (PSA density, lesion size and Likert score) have a significant impact on the progression-free survival (PFS) time.
Collapse
Affiliation(s)
- Iztok Caglic
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Nikita Sushentsev
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Vincent J Gnanapragasam
- Department of Urology, Addenbrooke's Hospital, Cambridge, UK
- Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK
- Cambridge Urology Translational Research and Clinical Trials Office, University of Cambridge, Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Evis Sala
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Nadeem Shaida
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Brendan C Koo
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Vasily Kozlov
- Department of Public Health and Healthcare Organisation, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Anne Y Warren
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Pathology, Addenbrooke's Hospital, Cambridge, UK
| | - Christof Kastner
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
- Department of Urology, Addenbrooke's Hospital, Cambridge, UK
| | - Tristan Barrett
- CamPARI Prostate Cancer Group, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
| |
Collapse
|
41
|
Van Nieuwenhove S, Van Damme J, Padhani AR, Vandecaveye V, Tombal B, Wuts J, Pasoglou V, Lecouvet FE. Whole-body magnetic resonance imaging for prostate cancer assessment: Current status and future directions. J Magn Reson Imaging 2020; 55:653-680. [PMID: 33382151 DOI: 10.1002/jmri.27485] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 12/20/2022] Open
Abstract
Over the past decade, updated definitions for the different stages of prostate cancer and risk for distant disease, along with the advent of new therapies, have remarkably changed the management of patients. The two expectations from imaging are accurate staging and appropriate assessment of disease response to therapies. Modern, next-generation imaging (NGI) modalities, including whole-body magnetic resonance imaging (WB-MRI) and nuclear medicine (most often prostate-specific membrane antigen [PSMA] positron emission tomography [PET]/computed tomography [CT]) bring added value to these imaging tasks. WB-MRI has proven its superiority over bone scintigraphy (BS) and CT for the detection of distant metastasis, also providing reliable evaluations of disease response to treatment. Comparison of the effectiveness of WB-MRI and molecular nuclear imaging techniques with regard to indications and the definition of their respective/complementary roles in clinical practice is ongoing. This paper illustrates the evolution of WB-MRI imaging protocols, defines the current state-of-the art, and highlights the latest developments and future challenges. The paper presents and discusses WB-MRI indications in the care pathway of men with prostate cancer in specific key situations: response assessment of metastatic disease, "all in one" cancer staging, and oligometastatic disease.
Collapse
Affiliation(s)
- Sandy Van Nieuwenhove
- Department of Radiology and Medical Imaging, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Julien Van Damme
- Department of Urology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Anwar R Padhani
- Mount Vernon Cancer Centre, Mount Vernon Hospital, London, UK
| | - Vincent Vandecaveye
- Department of Radiology and Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Bertrand Tombal
- Department of Urology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Joris Wuts
- Department of Radiology and Medical Imaging, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Vassiliki Pasoglou
- Department of Radiology and Medical Imaging, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Frederic E Lecouvet
- Department of Radiology and Medical Imaging, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| |
Collapse
|
42
|
Stanzione A, Creta M, Imbriaco M, La Rocca R, Capece M, Esposito F, Imbimbo C, Fusco F, Celentano G, Napolitano L, Mangiapia F, Mirone V, Longo N. Attitudes and perceptions towards multiparametric magnetic resonance imaging of the prostate: A national survey among Italian urologists. ACTA ACUST UNITED AC 2020; 92. [PMID: 33348956 DOI: 10.4081/aiua.2020.4.291] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/03/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We aimed to assess the attitudes and perceptions towards multiparametric magnetic resonance imaging (mpMRI) of the prostate among Italian urologists. MATERIAL AND METHODS A national, web-based survey was performed. A questionnaire composed of 18 multiple choice questions was e-mailed to 941 currently active urologists, members of the Italian Society of Urology. Preserving anonymity, respondents' demographics were collected (e.g. geographic region, type of workplace, prostate procedures performed) as well as data concerning their attitudes and perceptions towards mpMRI (e.g. indications deemed appropriate, degree of confidence in mpMRI results). Data were expressed as raw numbers and percentages of survey answers. RESULTS In total, 98 responses were received (participation rate = 10.4%). Respondents mostly worked in urban areas (96%) and primarily in hospital settings (89%), while 48% of them worked in southern Italy. 97% of respondents considered mpMRI useful to detect Prostate Cancer (PCa) in patients with prior negative biopsy, 64% in biopsy-naïve patients and 60% for PCa pre-operatory staging. About half (42%) of the participants declared that mpMRI results frequently lead them to change PCa management strategy. Standardization of mpMRI acquisition and reporting was partially unsatisfactory. Reported waiting time for mpMRI scans was longer than 4 weeks for 51% of respondents. The major limitation of this survey includes the small number of participants. CONCLUSIONS Prostate mpMRI is used by Italian urologists mainly for detection and for pre-operative staging of PCa. Further improvements in terms of mpMRI availability and report standardization are required.
Collapse
Affiliation(s)
- Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples.
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples.
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples.
| | - Roberto La Rocca
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples.
| | - Marco Capece
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples.
| | - Fabio Esposito
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy..
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples.
| | - Ferdinando Fusco
- Department of Woman Child and of General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples.
| | - Giuseppe Celentano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples.
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples.
| | - Francesco Mangiapia
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples.
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples.
| | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples.
| |
Collapse
|
43
|
Carpagnano FA, Eusebi L, Tupputi U, Testini V, Giannubilo W, Bartelli F, Guglielmi G. Multiparametric MRI: Local Staging of Prostate Cancer. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00374-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
44
|
Serum ProGRP as a novel biomarker of bone metastasis in prostate cancer. Clin Chim Acta 2020; 510:437-441. [DOI: 10.1016/j.cca.2020.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/24/2022]
|
45
|
Soeterik TFW, van Melick HHE, Dijksman LM, Biesma DH, Witjes JA, van Basten JPA. Multiparametric Magnetic Resonance Imaging Should Be Preferred Over Digital Rectal Examination for Prostate Cancer Local Staging and Disease Risk Classification. Urology 2020; 147:205-212. [PMID: 33129868 DOI: 10.1016/j.urology.2020.08.089] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/20/2020] [Accepted: 08/03/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To assess the impact of multiparametric magnetic resonance imaging (mp-MRI) local tumor staging on prostate cancer risk stratification and choice of treatment. MATERIALS AND METHODS Prostate cancer patients, newly diagnosed from 2017 to 2018 at 7 Dutch teaching hospitals were included. Risk group classification was done twice, using either digital rectal examination (DRE) or mp-MRI information. Risk group migration and rates of treatment intensification associated with mp-MRI upstaging were established. Diagnostic accuracy measures for the detection of nonorgan-confined disease (stage ≥T3a), for both DRE and mp-MRI, were assessed in patients undergoing robot-assisted radical prostatectomy. RESULTS A total of 1683 patients were included. Upstaging due to mp-MRI staging occurred in 493 of 1683 (29%) patients and downstaging in 43 of 1683 (3%) patients. Upstaging was associated with significant higher odds for treatment intensification (odds ratio [OR]: 3.5 95% confidence interval [CI] 1.9-6.5). Stage ≥T3a on mp-MRI was the most common reason for risk group upstaging (77%). Sensitivity for the detection of stage ≥T3a was higher for mp-MRI compared to DRE (51% vs 12%, P <.001), whereas specificity was lower (82% vs 97%, P <.001). Mp-MRI resulted in a significantly higher cumulative rate of true positive and true negative stage ≥T3a predictions compared with DRE (67% vs 58%, P <.001). CONCLUSION Use of mp-MRI tumor stage for prostate cancer risk classification leads to upstaging in 1 of 3 patients. Mp-MRI enables superior detection of nonorgan-confined disease compared with DRE, and should be the preferred tool for determining clinical tumor stage.
Collapse
Affiliation(s)
- Timo F W Soeterik
- Department of Value Based Healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Urology, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | | | - Lea M Dijksman
- Department of Value Based Healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Douwe H Biesma
- Department of Value Based Healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | |
Collapse
|
46
|
Soeterik TFW, van Melick HHE, Dijksman LM, Küsters-Vandevelde H, Stomps S, Schoots IG, Biesma DH, Witjes JA, van Basten JPA. Development and External Validation of a Novel Nomogram to Predict Side-specific Extraprostatic Extension in Patients with Prostate Cancer Undergoing Radical Prostatectomy. Eur Urol Oncol 2020; 5:328-337. [PMID: 32972895 DOI: 10.1016/j.euo.2020.08.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/04/2020] [Accepted: 08/18/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Prediction of side-specific extraprostatic extension (EPE) is crucial in selecting patients for nerve-sparing radical prostatectomy (RP). OBJECTIVE To develop and externally validate nomograms including multiparametric magnetic resonance imaging (mpMRI) information to predict side-specific EPE. DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis of 1870 consecutive prostate cancer patients who underwent robot-assisted RP from 2014 to 2018 at three institutions. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Four multivariable logistic regression models were established, including combinations of patient-based and side-specific variables: prostate-specific antigen (PSA) density, highest ipsilateral International Society of Urological Pathology (ISUP) biopsy grade, ipsilateral percentage of positive cores on systematic biopsy, and side-specific clinical stage assessed by both digital rectal examination and mpMRI. Discrimination (area under the curve [AUC]), calibration, and net benefit of these models were assessed in the development cohort and two external validation cohorts. RESULTS AND LIMITATIONS On external validation, AUCs of the four models ranged from 0.80 (95% confidence interval [CI] 0.68-0.88) to 0.83 (95% CI 0.72-0.90) in cohort 1 and from 0.77 (95% CI 0.62-0.87) to 0.78 (95% CI 0.64-0.88) in cohort 2. The three models including mpMRI staging information resulted in relatively higher AUCs compared with the model without mpMRI information. No major differences between the four models regarding net benefit were established. The model based on PSA density, ISUP grade, and mpMRI T stage was superior in terms of calibration. Using this model with a cut-off of 20%, 1980/2908 (68%) prostatic lobes without EPE would be found eligible for nerve sparing, whereas non-nerve sparing would be advised in 642/832 (77%) lobes with EPE. CONCLUSIONS Our analysis resulted in a simple and robust nomogram for the prediction of side-specific EPE, which should be used to select patients for nerve-sparing RP. PATIENT SUMMARY We developed a prediction model that can be used to assess accurately the likelihood of tumour extension outside the prostate. This tool can guide patient selection for safe nerve-sparing surgery.
Collapse
Affiliation(s)
- Timo F W Soeterik
- Department of Value-Based Healthcare, Santeon Group, Utrecht, The Netherlands; Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, Netherlands.
| | - Harm H E van Melick
- Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, Netherlands
| | - Lea M Dijksman
- Department of Value-Based Healthcare, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | | | - Saskia Stomps
- Department of Urology, Hospital Group Twente, Hengelo/Almelo, The Netherlands
| | - Ivo G Schoots
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Douwe H Biesma
- Department of Value-Based Healthcare, Santeon Group, Utrecht, The Netherlands
| | - J A Witjes
- Department of Urology, Radboud University Medical centre, Nijmegen, The Netherlands
| | | |
Collapse
|
47
|
Locally advanced prostate cancer imaging findings and implications for treatment from the surgical perspective. Abdom Radiol (NY) 2020; 45:865-877. [PMID: 31724081 DOI: 10.1007/s00261-019-02318-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The anatomy of the prostate is reviewed in the context of discussing the staging of prostate cancer and patterns of tumor spread. The utility of prostate magnetic resonance imaging along with new advancements in tumor staging are discussed specifically in locally advanced disease. What should be included in the radiology report carries a substantial weight to formulate the urologist's decision in regards to the selection of surgical candidates, preoperative planning and avoiding postoperative complications.
Collapse
|
48
|
Turchan WT, Kauffmann G, Patel P, Oto A, Liauw SL. PI-RADS score is associated with biochemical control and distant metastasis in men with intermediate-risk and high-risk prostate cancer treated with radiation therapy. Urol Oncol 2020; 38:600.e1-600.e8. [PMID: 31953005 DOI: 10.1016/j.urolonc.2019.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/27/2019] [Accepted: 12/19/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Novel methods of risk stratification are needed for men with prostate cancer. The Prostate Imaging Reporting and Data System (PI-RADS) uses multiparametric MRI (mpMRI) to assign a score indicating the likelihood of clinically significant prostate cancer. We evaluated pretreatment mpMRI findings, including PI-RADS score, as a marker for outcome in patients treated with primary radiation therapy (RT). METHODS One hundred and twenty-three men, 64% and 36% of whom had National Comprehensive Cancer Network (NCCN) intermediate-risk and high-risk disease, respectively, underwent mpMRI prior to RT. PI-RADS score and size of the largest nodule were analyzed with respect to freedom from biochemical failure (FFBF) and freedom from distant metastasis. RESULTS A PI-RADS score of ≤3, 4, or 5 was defined in 7%, 49%, and 44%; with a median nodule size of 0, 8, and 18 mm, respectively (P < 0.001). Median follow-up was 67 months. Men with PI-RADS ≤ 3, 4, or 5 disease had 7-year FFBF of 100%, 92%, and 65% (P = 0.002), and a 7-year freedom from distant metastasis of 100%, 100%, and 82%, respectively (P = 0.014). PI-RADS (Hazard Ratio 5.4 for PI-RADS 5 vs. 4, P = 0.006) remained associated with FFBF when controlling for NCCN risk category (P = 0.063) and receipt of androgen deprivation therapy (P = 0.535). Nodule size was also associated with FFBF (Hazard Ratio 1.08 per mm, P < 0.001) after controlling for NCCN risk category (P = 0.156) and receipt of androgen deprivation therapy (P = 0.776). CONCLUSION mpMRI findings, including PI-RADS score and nodule size, may improve risk stratification in men treated with primary RT.
Collapse
Affiliation(s)
| | - Greg Kauffmann
- University of Chicago, Department of Radiation and Cellular Oncology, Chicago, IL
| | - Pritesh Patel
- University of Chicago, Department of Radiology, Chicago, IL
| | - Aytek Oto
- University of Chicago, Department of Radiology, Chicago, IL
| | - Stanley L Liauw
- University of Chicago, Department of Radiation and Cellular Oncology, Chicago, IL.
| |
Collapse
|